Clinical effects of comprehensive treatment and liver transplantation for hepatocellular carcinoma exceeding Milan criteria: a comparative study

Objective To analyze and compare the clinical effects of comprehensive treatment and liver transplantation for hepatocellular carcinomas ( HCC) exceeding Milan criteria. Methods A retrospective analysis was performed on the clinical data of 157 patients with HCC ( exceeding Milan criteria) who received comprehensive treatment ( 99 patients, including 48 cases meeting Shanghai criteria) and liver transplantation ( 58 patients, including 26 cases meeting Shanghai criteria) in our hospital from January 2006 to January 2010. The median survival times and 1-, 2-, and 3- year survival rates were calculated by the Kaplan- Meier method, and the log- rank test was used for survival difference analysis. Results For all patients, the median survival times of the comprehensive treatment group and liver transplantation group were 18. 00 ± 1. 15 and 23. 40 ± 4. 44 months, respectively, and their 3- year survival rates were ( 18. 2 ± 3. 9) % and ( 39. 7 ±6.4) %, respectively; the survival was significantly improved by the treatment of liver transplantation ( P =0.009) . For patients meeting Shanghai criteria, the median survival times of the comprehensive treatment group and liver transplantation group were 20. 00 ± 1. 17 and 36. 00 ± 0. 00 months, respectively, and their 3- year survival rates were ( 25. 0 ± 6. 3) % and ( 57. 7 ± 9. 7) %, respectively; there was significant survival difference between the two groups ( P = 0. 008) . For patients exceeding Shanghai criteria, the median survival times of the comprehensive treatment group and liver transplantation group were 16. 00 ± 1. 78 and 16. 00 ± 1. 69 months, respectively, and their 3- year survival rates were ( 11. 8 ± 4. 5) % and ( 25. 0 ± 7. 7) %, respectively; there was no significant survival difference between the two groups ( P = 0. 221) . Conclusion Compared with comprehensive treatment, liver transplantation leads to a significant higher long- term survival rate in HCC patients exceeding Milan criteria but meeting Shanghai criteria. However, the two therapies cause no significant survival difference in HCC patients exceeding Shanghai criteria.