Comparative Analysis For The Prognostic Factors Of Patients With Hepatocellular Carcinoma Fulfilling The Milan Criteria Treated By Transplantation And Resection

Background:In recent years,with the technology development of liver transplantation,liver transplantation is supposed to be a first-choice treatment for hepatocellular carcinoma (HCC) within the Milan criteria even for patients with compensated cirrhosis(Child A),which leads an intense debate,but there is few convincing evidence in the literature to persuade each other.This study was to compare the prognostic factors on patients with HCC within the Milan criteria treated by transplantation or resection.Patients and Methods:Tumor characteristics and long-term survival of 1093 cirrhotic patients with curative resection and 100 cirrhotic patients with transplantation for HCC within the Milan criteria were compared in Zhongshan hospital between January of 2002 and December of 2006.A multivariate analysis was performed to determine the prognostic factors of survival in all patients with resection or transplantation.The overall and tumor recurrence-free survivals were computed using the Kaplan-Meier method and compared using the log-rank test.A P value＜0.05 was considered statistically significant.Results:The overall 1,2,4-year survival was better in the transplantation group than that in the resection group(96.0%,91.1%,88.8%vs 91.4%,82.2%,69.0%,P=-0.009). The overall 1,2,4-year tumor recurrence-free survival was better in the transplantation group than the resection group(98.0%,91.0%,91.0%vs 82.5%,71.4%,56.8%,P＜0.001).Multivariate analysis showed that tumor size,microscopic venous invasion,transplantation or curative resection,were independent prognostic factors.When stratified by tumor size into 2 strata(stratum A:tumor size≤2cm, stratum B:tumor size＞2cm),the overall 1,2,4-year survival was better in the transplantation group than that in the resection group among stratum B(94.9%,91.9%,87.2%vs 89.8%,80.1%,66.5%,P=0.016),but there was no significant difference between the transplantation and resection group among stratum A(94.7%,94.7%,94.7%vs 97.2%,90.0%,79.4%,P=-0.336).When stratified by the presence or absence of microscopic vascular invasion,the overall 1,2,4-year survival was better in the transplantation group than that in the resection group among those with microscopic vascular invasion(97.4%,94.1%,88.2%vs 87.5%,72.5%,59.8%, P=0.017),but there was no significant difference between the transplantation and resection group those without microscopic vascular invasion(93.4%,89.4%,89.4% vs 92.7%,85.2%,71.8%,P=0.104).Whatever stratified by tumor size or microscopic vascular invasion,The overall 4-year recurrence-free survival was better in the transplantation group than that in the resection group.Conclusions:Tumor size,microscopic venous invasion,transplantation or resection,are major prognostic factors of cirrhotic patients with HCC fulfilling the Milan criteria.When tumor size is larger than 2cm,patients treated by liver transplantation have longer long-term survival.