Comparing the Lifetime Survival in Patients With Early-Stage Hepatocellular Carcinoma Receiving Two Competitive Treatments: Liver Transplantation Versus Hepatic Resection

OBJECTIVES: Many surgeons seem to favor liver transplantation (LT) over hepatic resection (HR) on early-stage hepatocellular carcinoma (HCC) because of minimal recurrence and possibly longer survival. Based on a nationwide data followed for 17 year, we compared the lifetime survival of patients with early HCC who received LT versus HR.

METHODS: Taiwan’s nationwide data on HCC primarily treated with LT and HR were collected from 2002 to 2017 and followed until 2018. There were 14004 AJCC stage I and 9301 stage II patients. After excluding patients with severe cirrhosis, we applied a rolling-over algorithm to extrapolate survival function to lifetime and estimated life expectancy (LE) and loss-of-LE for comparison. The results were corroborated with 1:1 matched on age, sex, calendar year of treatment and major comorbidities.

RESULTS: The 5 and 10-year survival rate and LE of LT patients appeared better than HR patients for early-stage HCC, but the average age of LT patients was five years younger. There was no statistically significant difference for loss-of-LE in stage I HCC less than 2 cm between LT and HR (6.7 (S.E. 1.3) versus 6.6 (S.E. 1.2)). The results were corroborated by 1:1 matching for comparisons of LE (20.1(S.E. 1.3) versus 19.6 (S.E. 3.3)) and loss-of-LE (5.2 (S.E. 1.3) versus 5.6 (S.E. 3.3)). Stage II HCC received LT showed consistently longer LE and smaller loss-of-LE than HR.

CONCLUSIONS: Direct comparison of LE could be confounded by different ages, sex, and calendar year of treatment in real-world data. In HCC patients with small tumors at stage I without severe cirrhosis, LT did not show a lifetime survival advantage over HR.