Survival outcomes of liver transplantation versus liver resection among patients with hepatocellular carcinoma: A SEER-based longitudinal study

J Formos Med Assoc. 2019 Apr;118(4):790-796. doi: 10.1016/j.jfma.2018.09.015. Epub 2018 Oct 25.

Abstract

Background/purpose: This study aimed to compare the survival benefit in hepatocellular carcinoma (HCC) patients following liver transplantation or surgical resection utilizing Surveillance, Epidemiology, and End Results Program (SEER) database (2004-2013).

Methods: Overall and cancer-specific mortality were evaluated in HCC patients who were treated by liver resection or transplantation. Patients newly-diagnosed with primary HCC were included.

Results: Kaplan-Meier survival curves found that patients with liver transplantation had lower risk of overall mortality and cancer-free mortality than patients who received liver resection (P < 0.001). Multivariate analysis found the risk of overall and cancer-specific mortality were lower with liver transplantation than with resection (aHR = 0.51 for overall mortality and aHR = 0.37 for cancer specific mortality), and that the risk of overall mortality decreased for patients with liver transplantation relative to surgical resection as disease severity increased (T1: aHR = 0.53; T2: aHR = 0.47; T3 and T4: aHR = 0.33).

Conclusion: The findings indicated that transplantation has survival advantages compared with resection in treating patients with HCC, particularly in later stage disease.

Keywords: Hepatocellular carcinoma; Liver resection; Liver transplant; Mortality; Surveillance, Epidemiology, and End Results Program (SEER).

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / surgery*
  • Databases, Factual
  • Female
  • Hepatectomy / mortality*
  • Humans
  • Liver / pathology
  • Liver Neoplasms / mortality
  • Liver Neoplasms / surgery*
  • Liver Transplantation / mortality*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • SEER Program
  • Survival Analysis
  • Treatment Outcome
  • United States / epidemiology