A Comparison of Treatment Results with Liver Transplantation and Other Treatments in HCC Patients
Ki-Hun Kim, MD, PhD
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Ulsan University and Asan Medical Center, Seoul, Republic of Korea
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. It accounts for around 80% of primary liver cancers and the fourth most common cause of cancer-related death worldwide[1, 2]. There are several treatment options for HCC. Surgical treatments include surgical resection (SR) and liver transplantation (LT), and locoregional therapies include radiofrequency ablation (RFA), trans-arterial chemoembolization (TACE), trans-arterial radioembolization (TARE), and stereotactic body radiation therapy[2].
According to Meng et al., when comparing the groups that received RFA, HR, and LT in early single HCC, respectively, the LT group showed significantly better treatment outcomes than the RFA and HR groups (LT vs RFA; OR (95% CI) 1.34 [1.24-1.45], P<0.001, LT vs SR; OR 1.28[1.17-1.41], P<0.001)[3]. Also, Nomura et al. suggested that LT for patients with HCC is confirmed as the ideal treatment considering long-term survival. Furthermore, those with CTP score of ≧9 and/or tumor number of ≧3 may indicate priority for LT in HCC patients especially in patients who should be considered TACE, taking into account both short-term and long-term survivals[4]. According to Zhuang et al.’s data, the incremental survival benefit of LT over RFA was 4.5 months at 3 years, 12.4 months at 5 years, and 36.3 months at 10 years. Therefore, the authors suggested that the major advantage of LT is to achieve a benefit of longer survival[5].
According to the results of these recent studies, since LT in HCC has superior treatment results compared to other treatment methods significantly, it is necessary to actively consider LT in HCC patients at centers where the LDLT (living donor liver transplantation) program is active.