Surgical management of hepatocellular carcinoma in Child-Pugh class B cirrhotic patients: hepatic resection and/or microwave coagulation therapy versus living donor liver transplantation.

BACKGROUND: The surgical management of hepatocellular carcinoma (HCC) in cirrhotic patients with Child-Pugh class B remains controversial. The aim of this study was to compare the results of hepatic resection plus microwave coagulation therapy (MCT) versus living donor liver transplantation (LDLT) for HCC in cirrhotic patients with Child-Pugh class B.

MATERIAL/METHODS: Between January 1998 and June 2008, 30 patients underwent hepatic resection plus MCN and 40 patients underwent LDLT for HCC with Child-Pugh class B. Univariate and multivariate Cox proportional hazard models were established. Kaplan-Meier survival curves were generated, and a log-rank test was performed to compare group survival status.

RESULTS: There was no difference in overall survival after hepatic resection plus MCT (1-, 3-, and 5-year: 86.7%, 70.4%, and 70.4%, respectively) compared with LDLT (1-, 3-, and 5-year: 92.5%, 81.5%, and 72.6%, respectively). Disease-free survival was significantly better after LDLT compared with hepatic resection plus MCT. On multivariate analyses, the des-gamma-carboxy prothrombin (DCP) level of more 300 mAU/mL was an independent risk factor for overall survival and recurrence of HCC after LDLT. In preoperative Milan criteria met-patients, 5-year overall survival following LDLT was significantly better than that after hepatic resection plus MCT. Incidentally found hepatocellular carcinoma had higher tendency of well differentiated tumor in the explant liver after LDLT.

CONCLUSIONS: In preoperative Milan criteria met-cirrhotic patients with Child-Pugh class B, LDLT was associated with longer disease-free and overall survival than hepatic resection plus MCN. LDLT could not be indicated in the patients with DCP level of more 300 mAU/mL.