Comparison of Long-term Outcome According to Preoperative Clinical Course in Patients Undergone Liver Transplantation for Hepatocellular Carcinoma within Milan Criteria

ABSTRACT

PURPOSE: We wanted to evaluate the influence of preoperative non-surgical treatment and its duration for hepatocellular carcinoma (HCC) patients who underwent liver transplantation (LT). METHODS: We analyzed 75 patients with HCC who underwent living donor liver transplantation from January 1999 to December 2005. The median follow-up was 40.2 months. The patients were divided into the not treated group (26 patients) and non-surgically treated group (49 patients). We compared the overall survival (OS) and disease-free survival (DFS) rates of the 24 not treated patients with that of the 33 treated patients within the Milan criteria. The treated group was divided to 39 short-term ( or =3 years) treated patients by the preoperative treatment duration. The OS and DFS rates were analyzed. RESULTS: For 57 patients within the Milan criteria, the 1-, 3- and 5-year OS rates and the 1-, 3- and 5-year DFS rates were 80.0%, 68.5%, 64.8%, 82.0%, 77.2% and 75.1%, respectively. There were no different characteristic between the not treated group and the treated group, except for the mean age and the Child-Turcotte-Pugh score. Compared to the treated group, the OS and DFS rates were slightly better in the not treated group (p=0.053). There were more patients who underwent transcatheter arterial chemoembolization only in the short-term treated group and there were more patients who had microvascular invasion in the long-term treated group. The OS and DFS rates showed no significant difference between the two groups. CONCLUSION: It is possible that LT is a first treatment for HCC patients. If the patients' response to preoperative treatment was good, then their prognosis may be same regardless of the treatment duration.