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Liver Transplantation and Hepatic Resection can Achieve Cure for Hepatocellular Carcinoma

Pinna, Antonio Daniele, MD*; Yang, Tian, MD; Mazzaferro, Vincenzo, MD, PhD; De Carlis, Luciano, MD, FEBS§; Zhou, Jian, MD, PhD; Roayaie, Sasan, MD||; Shen, Feng, MD, PhD; Sposito, Carlo, MD, PhD; Cescon, Matteo, MD, PhD*; Di Sandro, Stefano, MD, PhD§; Yi-feng, He, MD; Johnson, Philip, MD, FRCP**; Cucchetti, Alessandro, MD*

doi: 10.1097/SLA.0000000000002889
ESA PAPERS

Objective: The aim of this study was to estimate probabilities of achieving the statistical cure from hepatocellular carcinoma (HCC) with hepatic resection (HR) and liver transplantation (LT).

Background: Statistical cure occurs when the mortality of a specific population returns to values of that of general population. Resection and transplantation are considered potentially curative therapies for HCC, but their effect on the residual entire life-expectancy has never been investigated.

Methods: Data from 3286 HCC patients treated with LT (n = 1218) or HR (n = 2068) were used to estimate statistical cure. Disease-free survival (DFS) was the primary survival measure to estimate cure fractions through a nonmixture model. Overall survival (OS) was a secondary measure. In both, patients were matched with general population by age, sex, year, and race/ethnicity. Cure variations after LT were also adjusted for different waiting-list drop-outs.

Results: Considering DFS, the cure fraction after LT was 74.1% and after HR was 24.1% (effect size >0.8). LT outperformed HR within all transplant criteria considered (effect size >0.8), especially for multiple tumors (>0.9) and even in presence of a drop-out up to 20% (>0.5). Considering OS, the cure fraction after LT marginally increased to 75.8%, and after that HR increased to 40.5%. The effect size of LT over HR in terms of cure decreased for oligonodular tumors (<0.5), became small for drop-out up to ∼20% (<0.2), and negligible for single tumors <5 cm (∼0.1).

Conclusion: As other malignancies, statistical cure can occur for HCC, primarily with LT and secondarily with HR, depending on waiting-list capabilities and efficacy of tumor recurrence therapies after resection.

*Department of Medical and Surgical Sciences – DIMEC, Alma Mater Studiorum – University of Bologna, Bologna, Italy

Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China

General Surgery and Liver Transplantation Unit, University of Milan and Istituto Nazionale Tumori (National Cancer Institute), IRCCS Foundation, Milan, Italy

§General Surgery and Abdominal Transplantation Unit, University of Milano-Bicocca and Niguarda-Cà Granda Hospital, Milan, Italy

Liver Surgery Department, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China

||Liver Cancer Program, White Plains Hospital - Montefiore Health System, White Plains, NY

**Department of Molecular and Clinical Cancer Medicine, The Duncan Building, University of Liverpool, Liverpool, UK.

Reprints: Antonio Daniele Pinna, MD, HPB and Transplantation, DDI, Cleveland Clinic Abu Dhabi, Al Falah Street, Al Maryah Island, Abu Dhabi 112412, United Arab Emirates. E-mail: PinnaA@ClevelandClinicAbuDhabi.ae.

Prof. A.D. Pinna is the ESA member of the abstract.

All authors hereby declare that there is no potential or actual personal, financial, or political interest related to this study.

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