Background. Early-stage hepatocellular carcinoma could benefit from upfront liver resection (LR) or liver transplantation (LT), but the optimal strategy in terms of tumor-related outcomes is still debated. We compared the oncological outcomes of LR and LT for hepatocellular carcinoma, stratifying the study population into a low-, intermediate-, and high-risk class according to the risk of death at 5-y predicted by a previously developed prognostic model. The impact of tumor pathology on oncological outcomes of low- and intermediate-risk patients undergoing LR was investigated as a secondary outcome.Methods. We performed a retrospective multicentric cohort study involving 2640 patients consecutively treated by LR or LT from 4 tertiary hepatobiliary and transplant centers between 2005 and 2015, focusing on patients amenable to both treatments upfront. Tumor-related survival and overall survival were compared under an intention-to-treat perspective.Results. We identified 468 LR and 579 LT candidates: 512 LT candidates underwent LT, whereas 68 (11.7%) dropped-out for tumor progression. Ninety-nine high-risk patients were selected from each treatment cohort after propensity score matching. Three and 5-y cumulative incidence of tumor-related death were 29.7% and 39.5% versus 17.2% and 18.3% for LR and LT group (P = 0.039), respectively. Low-risk and intermediate-risk patients treated by LR and presenting satellite nodules and microvascular invasion had a significantly higher 5-y incidence of tumor-related death (29.2% versus 12.5%; P < 0.001).Conclusions. High-risk patients showed significantly better intention-to-treat tumor-related survival after upfront LT rather than LR. Cancer-specific survival of low- and intermediate-risk LR patients was significantly impaired by unfavorable pathology, suggesting the application of ab-initio salvage LT in such scenarios.

Surgical Treatment of Hepatocellular Carcinoma: Multicenter Competing-risk Analysis of Tumor-related Death Following Liver Resection and Transplantation Under an Intention-to-treat Perspective / Di Sandro, Stefano; Sposito, Carlo; Ravaioli, Matteo; Lauterio, Andrea; Magistri, Paolo; Bongini, Marco; Odaldi, Federica; De Carlis, Riccardo; Botta, Francesca; Centonze, Leonardo; Maroni, Lorenzo; Citterio, Davide; Guidetti, Cristiano; Bagnardi, Vincenzo; De Carlis, Luciano; Cescon, Matteo; Mazzaferro, Vincenzo; Di Benedetto, Fabrizio; HV-HCC-MRT-group,. - In: TRANSPLANTATION. - ISSN 0041-1337. - 107:9(2023), pp. 1965-1975. [10.1097/tp.0000000000004593]

Surgical Treatment of Hepatocellular Carcinoma: Multicenter Competing-risk Analysis of Tumor-related Death Following Liver Resection and Transplantation Under an Intention-to-treat Perspective

Di Sandro, Stefano;Magistri, Paolo;Centonze, Leonardo;Guidetti, Cristiano;Di Benedetto, Fabrizio;
2023

Abstract

Background. Early-stage hepatocellular carcinoma could benefit from upfront liver resection (LR) or liver transplantation (LT), but the optimal strategy in terms of tumor-related outcomes is still debated. We compared the oncological outcomes of LR and LT for hepatocellular carcinoma, stratifying the study population into a low-, intermediate-, and high-risk class according to the risk of death at 5-y predicted by a previously developed prognostic model. The impact of tumor pathology on oncological outcomes of low- and intermediate-risk patients undergoing LR was investigated as a secondary outcome.Methods. We performed a retrospective multicentric cohort study involving 2640 patients consecutively treated by LR or LT from 4 tertiary hepatobiliary and transplant centers between 2005 and 2015, focusing on patients amenable to both treatments upfront. Tumor-related survival and overall survival were compared under an intention-to-treat perspective.Results. We identified 468 LR and 579 LT candidates: 512 LT candidates underwent LT, whereas 68 (11.7%) dropped-out for tumor progression. Ninety-nine high-risk patients were selected from each treatment cohort after propensity score matching. Three and 5-y cumulative incidence of tumor-related death were 29.7% and 39.5% versus 17.2% and 18.3% for LR and LT group (P = 0.039), respectively. Low-risk and intermediate-risk patients treated by LR and presenting satellite nodules and microvascular invasion had a significantly higher 5-y incidence of tumor-related death (29.2% versus 12.5%; P < 0.001).Conclusions. High-risk patients showed significantly better intention-to-treat tumor-related survival after upfront LT rather than LR. Cancer-specific survival of low- and intermediate-risk LR patients was significantly impaired by unfavorable pathology, suggesting the application of ab-initio salvage LT in such scenarios.
2023
107
9
1965
1975
Surgical Treatment of Hepatocellular Carcinoma: Multicenter Competing-risk Analysis of Tumor-related Death Following Liver Resection and Transplantation Under an Intention-to-treat Perspective / Di Sandro, Stefano; Sposito, Carlo; Ravaioli, Matteo; Lauterio, Andrea; Magistri, Paolo; Bongini, Marco; Odaldi, Federica; De Carlis, Riccardo; Botta, Francesca; Centonze, Leonardo; Maroni, Lorenzo; Citterio, Davide; Guidetti, Cristiano; Bagnardi, Vincenzo; De Carlis, Luciano; Cescon, Matteo; Mazzaferro, Vincenzo; Di Benedetto, Fabrizio; HV-HCC-MRT-group,. - In: TRANSPLANTATION. - ISSN 0041-1337. - 107:9(2023), pp. 1965-1975. [10.1097/tp.0000000000004593]
Di Sandro, Stefano; Sposito, Carlo; Ravaioli, Matteo; Lauterio, Andrea; Magistri, Paolo; Bongini, Marco; Odaldi, Federica; De Carlis, Riccardo; Botta,...espandi
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1355726
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