Resection vs. Transplantation as Curative Treatment Options for Hepatocellular Carcinoma in Cirrhosis – Systematic Review

Objective: To systematically review the literature on resection (Rx) and liver transplantation (LT) for hepatocellular carcinoma (HCC) in patients with cirrhosis. HCC is the fifth most neoplasm worldwide. Current standard therapeutic strategies include resection and LT w or w/o prior bridging procedures. Organ shortage leads to discussion whether HCC should be transplanted or whether resection can achieve similar results.Methods and Aims: A systematic review was performed. Studies investigating Rx vs. LT, and Rx or LT only, and in which patients were regarded to be both resectable and transplantable between 1998 and 2011 were included in the analysis. The primary endpoint was overall survival (OS). Secondary endpoints were disease free survival (DFS) as well as prognostic factors (AFP, tumor size and number, micro- and macrovascular invasion, stadium of cirrhosis, MELD-score, bridging therapies etc.). The results should serve as a decision-making basis to either transplant or resect the patient primarily in case of HCC-diagnosis. Results: Database research revealed a total 843 hits. To date there is no randomized controlled trial (RCT) investigating Rx vs. LT for HCC. A total of 71 publications were eligible. OS and DFS data for LT and Rx differ significantly between groups favoring LT. However, surrogate predictive markers for outcome reveal a lower microvascular invasion, a better differentiation, less microsatellites, smaller tumors and lower pre-treatment AFP values in patients being transplanted. Conclusion: Current evidence does not allow a meaningful comparison between patients undergoing Rx or LT for HCC. There are no data from randomized controlled trials. Analyses do not compare patients in a comparable tumor stadium. A RCT in patients without contraindications for transplantation or resection and comparable surrogate characteristics should be initiated investigating the hypothesis that resection of HCC achieves similar results than transplantation.

Evidence - HCC - Resection - Transplantation