Original ResearchTransplantation versus hepatectomy for HCC beyond the Milan criteria: A propensity score analysis

•Our propensity-score-matched study provided evidences to support the use of LT in HCC patients beyond Milan criteria.•Patients with AFP >800 ng/ml or tumor > 8 cm achieved similar survival benefits from both therapy.•patients with AFP ≤800 ng/ml or tumor ≤ 8 cm, LT had more advantages on prognosis of HCC beyond Milan criteria.

BackgroundIncreasing studies have suggested that surgical resection (SR) or liver transplantation (LT) could bring survival benefits for patients with hepacelluar carcinoma (HCC) beyond Milan criteria. This study compared the long-term survival of patients beyond the Milan criteria who received SR or LT.Material and methodsA total of 461 HCC patients were retrospectively collected. Analysis was performed using propensity score matching (PSM), the Kaplan-Meier method and the Cox proportional hazards model.ResultsPrognosis was significantly better for the LT group than the SR group before (P < 0.001) and after PSM(p = 0.003). In subgroup analysis, for patients with lower AFP level, the 1-, 3-, and 5-year OS rates for the two groups were significantly different (86.7, 71.9, and 71.9% for group LT vs. 75.8, 48.1, and 10.7% for group SR, P = 0.003). For patients with smaller tumor size, the 1-, 3-, and 5-year OS rates were 78.3, 66.7, and 66.7% for group LT, and 83.8, 42.6, and 18.6% for group SR, p = 0.009). Transplantation was a favorable factor associated with prognosis before and after propensity score matching (HR 2.643).ConclusionOur propensity model suggested that LT provided significantly better long-term survival than SR for HCC beyond Milan criteria before and after PSM.