Comparative analysis of outcome in patients with hepatocellular carcinoma exceeding the milan criteria treated with liver transplantation versus partial hepatectomy

Robert J Canter, Siddharth A. Patel, Timothy Kennedy, Michael I. Dangelica, William R. Jarnagin, Yuman Fong, Leslie H. Blumgart, Richard B. Freeman, Ronald P. Dematteo, Peter L. Abt

Research output: Contribution to journalArticle

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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 languageEnglish (US)
Pages (from-to)466-471
Number of pages6
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume34
Issue number5
DOIs
StatePublished - Oct 2011
Externally publishedYes

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Hepatectomy
Liver Transplantation
Hepatocellular Carcinoma
San Francisco
Neoplasms
End Stage Liver Disease
Survival
Hepacivirus
Patient Selection
Registries
Fibrosis

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 journalArticle

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. / Comparative analysis of outcome in patients with hepatocellular carcinoma exceeding the milan criteria treated with liver transplantation versus partial hepatectomy. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2011 ; Vol. 34, No. 5. pp. 466-471.
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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.",
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AU - Canter, Robert J

AU - Patel, Siddharth A.

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AU - Dangelica, Michael I.

AU - Jarnagin, William R.

AU - Fong, Yuman

AU - Blumgart, Leslie H.

AU - Freeman, Richard B.

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AU - Abt, Peter L.

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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.

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