Abstract
INTRODUCTION: Proponents of orthotopic liver transplantation (TXP) for the treatment of hepatocellular carcinoma (HCC) advocate expanding the Milan criteria. We performed a matched analysis comparing patients treated with TXP to patients treated with partial hepatectomy (PHX) for HCC exceeding the Milan criteria. METHODS: From the United Network for Organ Sharing registry, we identified 92 US patients with HCC exceeding the Milan criteria who underwent TXP between 2002 and 2005. During the same period, 94 patients with similar tumor size criteria underwent PHX at a single center. Data were analyzed using χ, parametric, nonparametric, and Kaplan-Meier methods. RESULTS: TXP patients were more commonly male (82% vs. 65%, P=0.01) and had a higher Model for End Stage Liver Disease score (median 11 vs. 7, P<0.001). Pathologic cirrhosis (79% TXP vs. 38% PHX, P<0.001), particularly secondary to hepatitis C virus (29% TXP vs. 5% PHX, P<0.001), was more common among TXP patients. Mean cumulative tumor size was 10.0 cm (63% exceeding University of California at San Francisco criteria) among PHX patients compared with 6.4 cm (20% exceeding University of California at San Francisco criteria) for TXP patients (P<0.001). With a median follow-up of 34 months (range, 1-86), 3-year survival was similar between the cohorts (66%±10% for TXP vs. 66%±10% for PHX, P=0.97). Cancer deaths (26/37, 70%) were more prevalent among PHX patients, whereas noncancer deaths (25/37, 68%) were common in TXP patients (P<0.001). CONCLUSIONS: Among heterogeneous patients with HCC who exceed the Milan criteria, TXP and PHX achieve similar overall survival. Further study is needed to ensure appropriate patient selection for these disparate therapies.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 466-471 |
| Number of pages | 6 |
| Journal | American Journal of Clinical Oncology: Cancer Clinical Trials |
| Volume | 34 |
| Issue number | 5 |
| DOIs | |
| State | Published - Oct 2011 |
| Externally published | Yes |
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Keywords
- expanded criteria
- hepatocellular carcinoma
- liver transplantation
- partial hepatectomy
ASJC Scopus subject areas
- Oncology
- Cancer Research
Cite this
Comparative analysis of outcome in patients with hepatocellular carcinoma exceeding the milan criteria treated with liver transplantation versus partial hepatectomy. / Canter, Robert J; Patel, Siddharth A.; Kennedy, Timothy; Dangelica, Michael I.; Jarnagin, William R.; Fong, Yuman; Blumgart, Leslie H.; Freeman, Richard B.; Dematteo, Ronald P.; Abt, Peter L.
In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 34, No. 5, 10.2011, p. 466-471.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Comparative analysis of outcome in patients with hepatocellular carcinoma exceeding the milan criteria treated with liver transplantation versus partial hepatectomy
AU - Canter, Robert J
AU - Patel, Siddharth A.
AU - Kennedy, Timothy
AU - Dangelica, Michael I.
AU - Jarnagin, William R.
AU - Fong, Yuman
AU - Blumgart, Leslie H.
AU - Freeman, Richard B.
AU - Dematteo, Ronald P.
AU - Abt, Peter L.
PY - 2011/10
Y1 - 2011/10
N2 - INTRODUCTION: Proponents of orthotopic liver transplantation (TXP) for the treatment of hepatocellular carcinoma (HCC) advocate expanding the Milan criteria. We performed a matched analysis comparing patients treated with TXP to patients treated with partial hepatectomy (PHX) for HCC exceeding the Milan criteria. METHODS: From the United Network for Organ Sharing registry, we identified 92 US patients with HCC exceeding the Milan criteria who underwent TXP between 2002 and 2005. During the same period, 94 patients with similar tumor size criteria underwent PHX at a single center. Data were analyzed using χ, parametric, nonparametric, and Kaplan-Meier methods. RESULTS: TXP patients were more commonly male (82% vs. 65%, P=0.01) and had a higher Model for End Stage Liver Disease score (median 11 vs. 7, P<0.001). Pathologic cirrhosis (79% TXP vs. 38% PHX, P<0.001), particularly secondary to hepatitis C virus (29% TXP vs. 5% PHX, P<0.001), was more common among TXP patients. Mean cumulative tumor size was 10.0 cm (63% exceeding University of California at San Francisco criteria) among PHX patients compared with 6.4 cm (20% exceeding University of California at San Francisco criteria) for TXP patients (P<0.001). With a median follow-up of 34 months (range, 1-86), 3-year survival was similar between the cohorts (66%±10% for TXP vs. 66%±10% for PHX, P=0.97). Cancer deaths (26/37, 70%) were more prevalent among PHX patients, whereas noncancer deaths (25/37, 68%) were common in TXP patients (P<0.001). CONCLUSIONS: Among heterogeneous patients with HCC who exceed the Milan criteria, TXP and PHX achieve similar overall survival. Further study is needed to ensure appropriate patient selection for these disparate therapies.
AB - INTRODUCTION: Proponents of orthotopic liver transplantation (TXP) for the treatment of hepatocellular carcinoma (HCC) advocate expanding the Milan criteria. We performed a matched analysis comparing patients treated with TXP to patients treated with partial hepatectomy (PHX) for HCC exceeding the Milan criteria. METHODS: From the United Network for Organ Sharing registry, we identified 92 US patients with HCC exceeding the Milan criteria who underwent TXP between 2002 and 2005. During the same period, 94 patients with similar tumor size criteria underwent PHX at a single center. Data were analyzed using χ, parametric, nonparametric, and Kaplan-Meier methods. RESULTS: TXP patients were more commonly male (82% vs. 65%, P=0.01) and had a higher Model for End Stage Liver Disease score (median 11 vs. 7, P<0.001). Pathologic cirrhosis (79% TXP vs. 38% PHX, P<0.001), particularly secondary to hepatitis C virus (29% TXP vs. 5% PHX, P<0.001), was more common among TXP patients. Mean cumulative tumor size was 10.0 cm (63% exceeding University of California at San Francisco criteria) among PHX patients compared with 6.4 cm (20% exceeding University of California at San Francisco criteria) for TXP patients (P<0.001). With a median follow-up of 34 months (range, 1-86), 3-year survival was similar between the cohorts (66%±10% for TXP vs. 66%±10% for PHX, P=0.97). Cancer deaths (26/37, 70%) were more prevalent among PHX patients, whereas noncancer deaths (25/37, 68%) were common in TXP patients (P<0.001). CONCLUSIONS: Among heterogeneous patients with HCC who exceed the Milan criteria, TXP and PHX achieve similar overall survival. Further study is needed to ensure appropriate patient selection for these disparate therapies.
KW - expanded criteria
KW - hepatocellular carcinoma
KW - liver transplantation
KW - partial hepatectomy
UR - http://www.scopus.com/inward/record.url?scp=80053360997&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80053360997&partnerID=8YFLogxK
U2 - 10.1097/COC.0b013e3181ec63dd
DO - 10.1097/COC.0b013e3181ec63dd
M3 - Article
C2 - 20938319
AN - SCOPUS:80053360997
VL - 34
SP - 466
EP - 471
JO - American Journal of Clinical Oncology
JF - American Journal of Clinical Oncology
SN - 0277-3732
IS - 5
ER -