Long-term outcome of liver resection versus transplantation for hepatocellular carcinoma in a region where living donation is a main source

Pil Soo Sung; Hyun Yang; Gun Hyung Na; Seawon Hwang; Donghoon Kang; Jeong Won Jang; Si Hyun Bae; Jong Young Choi; Dong Goo Kim; Seung Kew Yoon; Young Kyoung You

doi:10.12659/AOT.904287

Long-term outcome of liver resection versus transplantation for hepatocellular carcinoma in a region where living donation is a main source

Pil Soo Sung, Hyun Yang, Gun Hyung Na, Seawon Hwang, Donghoon Kang, Jeong Won Jang, Si Hyun Bae, Jong Young Choi, Dong Goo Kim, Seung Kew Yoon, Young Kyoung You

Catholic Univ. of Korea Coll. Med.

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Background: The aim of this study was to define the best curative strategy in patients with hepatocellular carcinoma (HCC) in a hepatitis B virus (HBV)-endemic region where living donation dominates the type of cadaveric donation for liver transplantation (LT). Material/Methods: A retrospective cohort comprised those patients whose clinical course could potentially be traced for at least 10 years. We found 262 HCC patients who had undergone curative surgical treatment from March 1997 to August 2006. Among these patients, 156 were treated with liver resection (LR) (R group) and 106 patients underwent LT (T group, 100 patients with living donor). Tumor characteristics, overall survival (OS), and recurrence-free survival (RFS) were analyzed. Results: Postoperative mortality was not significantly different between the groups, whereas recurrence rate during the study period (until August 2016) was higher in the R group (56% in the R group versus 19% in the T group, p<0.001). The 10-year and 15-year OS and RFS were better in the T group. Subgroup analysis with patients having solitary and ≤5 cm tumor by preoperative imaging showed that the 10-year and 15-year OS and RFS were much better in the T group, irrespective of their preoperative liver function defined by MELD score. In the T group, resection as the surgical procedure and tumor size on histology were poor prognostic factors for RFS. Importantly, this superiority of LT over LR in OS and RFS applied only to the patients with relatively low preoperative alpha-fetoprotein (AFP) levels (AFP <100 ng/mL), because patients with higher levels compared with lower levels of AFP tended to have more recurrent tumors after LT, but not in the case of LR during long-term follow-up. Conclusions: Overall, LT was associated with better survival outcomes than resection in patients with HCC in Korea, where living donation is a main transplant source.

Original language	English
Pages (from-to)	276-284
Number of pages	9
Journal	Annals of Transplantation
Volume	22
DOIs	https://doi.org/10.12659/AOT.904287
State	Published - 2017

Bibliographical note

Funding Information:
This work was supported by Research Fund of Seoul St. Mary’s Hospital, The Catholic University of Korea. This work was also supported by grants of the National Research Foundation of Korea grant funded by the Korea government (NRF-2015R1A2A1A15052783) of the Ministry of Science, ICT and Future Planning through the National Research Foundation

Publisher Copyright:
© Ann Transplant.

Keywords

Alpha-fetoproteins
Carcinoma
Hepatocellular
Liver transplantation
Recurrence

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.12659/AOT.904287

Cite this

@article{d4706901d7d040cfa4ba64e47d62dada,

title = "Long-term outcome of liver resection versus transplantation for hepatocellular carcinoma in a region where living donation is a main source",

abstract = "Background: The aim of this study was to define the best curative strategy in patients with hepatocellular carcinoma (HCC) in a hepatitis B virus (HBV)-endemic region where living donation dominates the type of cadaveric donation for liver transplantation (LT). Material/Methods: A retrospective cohort comprised those patients whose clinical course could potentially be traced for at least 10 years. We found 262 HCC patients who had undergone curative surgical treatment from March 1997 to August 2006. Among these patients, 156 were treated with liver resection (LR) (R group) and 106 patients underwent LT (T group, 100 patients with living donor). Tumor characteristics, overall survival (OS), and recurrence-free survival (RFS) were analyzed. Results: Postoperative mortality was not significantly different between the groups, whereas recurrence rate during the study period (until August 2016) was higher in the R group (56% in the R group versus 19% in the T group, p<0.001). The 10-year and 15-year OS and RFS were better in the T group. Subgroup analysis with patients having solitary and ≤5 cm tumor by preoperative imaging showed that the 10-year and 15-year OS and RFS were much better in the T group, irrespective of their preoperative liver function defined by MELD score. In the T group, resection as the surgical procedure and tumor size on histology were poor prognostic factors for RFS. Importantly, this superiority of LT over LR in OS and RFS applied only to the patients with relatively low preoperative alpha-fetoprotein (AFP) levels (AFP <100 ng/mL), because patients with higher levels compared with lower levels of AFP tended to have more recurrent tumors after LT, but not in the case of LR during long-term follow-up. Conclusions: Overall, LT was associated with better survival outcomes than resection in patients with HCC in Korea, where living donation is a main transplant source.",

keywords = "Alpha-fetoproteins, Carcinoma, Hepatocellular, Liver transplantation, Recurrence",

author = "Sung, {Pil Soo} and Hyun Yang and Na, {Gun Hyung} and Seawon Hwang and Donghoon Kang and Jang, {Jeong Won} and Bae, {Si Hyun} and Choi, {Jong Young} and Kim, {Dong Goo} and Yoon, {Seung Kew} and You, {Young Kyoung}",

note = "Funding Information: This work was supported by Research Fund of Seoul St. Mary{\textquoteright}s Hospital, The Catholic University of Korea. This work was also supported by grants of the National Research Foundation of Korea grant funded by the Korea government (NRF-2015R1A2A1A15052783) of the Ministry of Science, ICT and Future Planning through the National Research Foundation Publisher Copyright: {\textcopyright} Ann Transplant.",

year = "2017",

doi = "10.12659/AOT.904287",

language = "English",

volume = "22",

pages = "276--284",

journal = "Annals of Transplantation",

issn = "1425-9524",

publisher = "International Scientific Information, Inc.",

}

TY - JOUR

T1 - Long-term outcome of liver resection versus transplantation for hepatocellular carcinoma in a region where living donation is a main source

AU - Sung, Pil Soo

AU - Yang, Hyun

AU - Na, Gun Hyung

AU - Hwang, Seawon

AU - Kang, Donghoon

AU - Jang, Jeong Won

AU - Bae, Si Hyun

AU - Choi, Jong Young

AU - Kim, Dong Goo

AU - Yoon, Seung Kew

AU - You, Young Kyoung

N1 - Funding Information: This work was supported by Research Fund of Seoul St. Mary’s Hospital, The Catholic University of Korea. This work was also supported by grants of the National Research Foundation of Korea grant funded by the Korea government (NRF-2015R1A2A1A15052783) of the Ministry of Science, ICT and Future Planning through the National Research Foundation Publisher Copyright: © Ann Transplant.

PY - 2017

Y1 - 2017

N2 - Background: The aim of this study was to define the best curative strategy in patients with hepatocellular carcinoma (HCC) in a hepatitis B virus (HBV)-endemic region where living donation dominates the type of cadaveric donation for liver transplantation (LT). Material/Methods: A retrospective cohort comprised those patients whose clinical course could potentially be traced for at least 10 years. We found 262 HCC patients who had undergone curative surgical treatment from March 1997 to August 2006. Among these patients, 156 were treated with liver resection (LR) (R group) and 106 patients underwent LT (T group, 100 patients with living donor). Tumor characteristics, overall survival (OS), and recurrence-free survival (RFS) were analyzed. Results: Postoperative mortality was not significantly different between the groups, whereas recurrence rate during the study period (until August 2016) was higher in the R group (56% in the R group versus 19% in the T group, p<0.001). The 10-year and 15-year OS and RFS were better in the T group. Subgroup analysis with patients having solitary and ≤5 cm tumor by preoperative imaging showed that the 10-year and 15-year OS and RFS were much better in the T group, irrespective of their preoperative liver function defined by MELD score. In the T group, resection as the surgical procedure and tumor size on histology were poor prognostic factors for RFS. Importantly, this superiority of LT over LR in OS and RFS applied only to the patients with relatively low preoperative alpha-fetoprotein (AFP) levels (AFP <100 ng/mL), because patients with higher levels compared with lower levels of AFP tended to have more recurrent tumors after LT, but not in the case of LR during long-term follow-up. Conclusions: Overall, LT was associated with better survival outcomes than resection in patients with HCC in Korea, where living donation is a main transplant source.

AB - Background: The aim of this study was to define the best curative strategy in patients with hepatocellular carcinoma (HCC) in a hepatitis B virus (HBV)-endemic region where living donation dominates the type of cadaveric donation for liver transplantation (LT). Material/Methods: A retrospective cohort comprised those patients whose clinical course could potentially be traced for at least 10 years. We found 262 HCC patients who had undergone curative surgical treatment from March 1997 to August 2006. Among these patients, 156 were treated with liver resection (LR) (R group) and 106 patients underwent LT (T group, 100 patients with living donor). Tumor characteristics, overall survival (OS), and recurrence-free survival (RFS) were analyzed. Results: Postoperative mortality was not significantly different between the groups, whereas recurrence rate during the study period (until August 2016) was higher in the R group (56% in the R group versus 19% in the T group, p<0.001). The 10-year and 15-year OS and RFS were better in the T group. Subgroup analysis with patients having solitary and ≤5 cm tumor by preoperative imaging showed that the 10-year and 15-year OS and RFS were much better in the T group, irrespective of their preoperative liver function defined by MELD score. In the T group, resection as the surgical procedure and tumor size on histology were poor prognostic factors for RFS. Importantly, this superiority of LT over LR in OS and RFS applied only to the patients with relatively low preoperative alpha-fetoprotein (AFP) levels (AFP <100 ng/mL), because patients with higher levels compared with lower levels of AFP tended to have more recurrent tumors after LT, but not in the case of LR during long-term follow-up. Conclusions: Overall, LT was associated with better survival outcomes than resection in patients with HCC in Korea, where living donation is a main transplant source.

KW - Alpha-fetoproteins

KW - Carcinoma

KW - Hepatocellular

KW - Liver transplantation

KW - Recurrence

UR - http://www.scopus.com/inward/record.url?scp=85019645291&partnerID=8YFLogxK

U2 - 10.12659/AOT.904287

DO - 10.12659/AOT.904287

M3 - Article

C2 - 28473688

AN - SCOPUS:85019645291

SN - 1425-9524

VL - 22

SP - 276

EP - 284

JO - Annals of Transplantation

JF - Annals of Transplantation

ER -

Long-term outcome of liver resection versus transplantation for hepatocellular carcinoma in a region where living donation is a main source

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this