Transplant Versus Non-Transplant Hepatocellular Carcinoma Patient Characteristics And Survival.

Background and Objectives: Survival of patients treated by liver transplantation for hepatocellular carcinoma (HCC) remains excellent, with more that 75% 5-year survival. By contrast, overall survival of HCC patients in large populations remains less than 30% at 5 years. Our aims were to examine whether this discrepancy was due to the low proportion of patients who get treated by liver transplant in our HCC cohort and why. Materials and Methods: New patients presenting with HCC at our institution over the last 5 years were evaluated in this prospective study. Baseline tumor evaluation was done by CAT scan and routine hematology and liver function laboratory values were recorded, as was survival. Results: Almost all new HCC patients (n=628) over 5 years at Inonu University hospital were evaluated. 191 patients (30.4% of the total cohort) received potentially curative and survival-extending liver transplants, while 384 patients (61.1% of the total cohort) received non-surgical therapies, 53 patients (8.4%) could not receive any oncologic therapy.Transplanted HCC patients had smaller, less aggressive HCCs, worse liver function and a mean survival of 43.06 + 1.41 months. Non-surgically treated HCC patients had larger, more aggressive HCCs, better liver function, and a mean survival of 31.51±1.53 months, p<0.001. No-therapy patients had both most aggressive HCCs and worst liver function, and a mean survival of 4.41±0.95 months. Conclusions: Survival after liver transplant was significantly longer than without liver transplant. Future efforts need to focus on HCC prevention, early detection, and in identifying/treating additional HCC patients who could be rendered transplant-eligible. Lay summary: Long survival is mainly associated with liver transplant, yet only one third of our patients were eligible for transplant, because the other patients had tumors that were too advanced for transplantation at presentation. Simple Summary: Hepatocellular carcinoma (HCC) is essentially cured (>75% 5-years survival) when patients within accepted criteria are treated by liver transplant. Other, non-surgical treatments result in dramatically shorter survival times. We collected data on all patients being referred for HCC treatment over a 5-year period and found that only 30.4% were offered transplant. To investigate the reasons, we compared baseline clinical and tumor characteristics of all new patients on presentation at our institute and found that transplanted patients have smaller and less aggressive HCCs. We discuss whether this is due to a different HCC biology or absence of surveillance or whether the transplant criteria might be too stringent.