Recurrence-free Survival After Liver Transplantation Versus Surgical Resection for Hepatocellular Carcinoma: Role of High-risk MRI Features

Transplantation. 2024 Jan 1;108(1):215-224. doi: 10.1097/TP.0000000000004675. Epub 2023 Jun 8.

Abstract

Background: This study aimed to evaluate recurrence-free survival (RFS) and overall survival (OS) after liver transplantation (LT) or liver resection (LR) for hepatocellular carcinoma (HCC) and perform subgroup analysis for HCC with high-risk imaging findings for recurrence on preoperative liver magnetic resonance imaging (MRI; high-risk MRI features).

Methods: We included patients with HCC eligible for both LT and LR and received either of the treatments between June 2008 and February 2021 from 2 tertiary referral medical centers after propensity score-matching. RFS and OS were compared between LT and LR using Kaplan-Meier curves with the log-rank test.

Results: Propensity score-matching yielded 79 patients in the LT group and 142 patients in the LR group. High-risk MRI features were noted in 39 patients (49.4%) in the LT group and 98 (69.0%) in the LR group. The Kaplan-Meier curves for RFS and OS were not significantly different between the 2 treatments among the high-risk group (RFS, P = 0.079; OS, P = 0.755). Multivariable analysis showed that treatment type was not a prognostic factor for RFS and OS ( P = 0.074 and 0.937, respectively).

Conclusions: The advantage of LT over LR for RFS may be less evident among patients with high-risk MRI features.

MeSH terms

  • Carcinoma, Hepatocellular* / diagnostic imaging
  • Carcinoma, Hepatocellular* / pathology
  • Carcinoma, Hepatocellular* / surgery
  • Hepatectomy / adverse effects
  • Hepatectomy / methods
  • Humans
  • Liver Neoplasms* / diagnostic imaging
  • Liver Neoplasms* / pathology
  • Liver Neoplasms* / surgery
  • Liver Transplantation* / adverse effects
  • Liver Transplantation* / methods
  • Retrospective Studies