Limitation of non-transplant treatment and proper timing for liver transplantation in patients with hepatocellular carcinoma considering long-term survival

In this study, we investigated the long-term survival of patients with hepatocellular carcinoma (HCC) after conventional treatment other than liver transplantation (LT) in our institute and discuss the limitation of non-transplant treatment for HCC and the proper indictors of LT in the recent comprehensive era. Between 2003 and 2016, 181 patients with HCC aged ≤70 years received active treatment including liver resection, radiofrequency ablation (RFA), and transcatheter arterial chemoembolization (TACE). We analyzed the factors associated with overall survival and proposed new priority for the indicators of LT in HCC patients according to the extracted factors by comparing the survival with 39 transplanted patients with HCC. Child-Turcotte-Pugh (CTP) score (HR: 1.276; 95% CI: 1.049-1.552, P=.015), and number of tumors (HR: 1.238; 95% CI: 1.112- 1.377, P<.001) were selected as significant factors associated with the survival after active treatments for HCC. Patients with LT had significantly better long-term survival compared with those with non-transplant patients regardless of aforementioned factors. However, regarding relatively short survival (3 years), patients with CTP score of ≥9and/or ≥3 tumors with non-transplant treatment had poorer survival compared with those of transplanted patients (P<.05). We propose that CTP score of 9 and/or 3 tumors before non-transplant, intensive treatment might be a new priority for considering indicators of LT in patients with HCC. Abbreviations: AASLD = American Association of Liver Disease, AFP = serum alphafetoproetein, APASL = Asian Pacific Association for the Study of Liver diseases, BCLC = Barcelona Clinic Liver Cancer, CTP = Child-Turcotte-Pugh, DCP = des-gamma carboxy prothrombin, EASL = European Association for the Study of Liver, EORTC = European Organisation for Research and Treatment of Cancer, HCC = hepatocellular carcinoma, HCV = Hepatitis C virus, JSH = Japanese Society of Hepatology, LT = liver transplantation, MELD = model of end-stage liver disease, NCCN = National Comprehensive Cancer Network, PIVKA-II = protein induced by vitamin K absence or antagonists II, RFA = radiofrequency ablation, TACE = transcatheter arterial chemoembolization.