Survival outcomes of liver transplantation versus liver resection among patients with hepatocellular carcinoma: A SEER-based longitudinal study

BACKGROUND/PURPOSE: This study aimed to compare the survival benefit in hepatocellular carcinoma (HCC) patients following liver transplantation or surgical resection utilizing Surveillance, Epidemiology, and End Results Program (SEER) database (2004-2013). METHODS: Overall and cancer-specific mortality were evaluated in HCC patients who were treated by liver resection or transplantation. Patients newly-diagnosed with primary HCC were included. RESULTS: Kaplan-Meier survival curves found that patients with liver transplantation had lower risk of overall mortality and cancer-free mortality than patients who received liver resection (P < 0.001). Multivariate analysis found the risk of overall and cancer-specific mortality were lower with liver transplantation than with resection (aHR = 0.51 for overall mortality and aHR = 0.37 for cancer specific mortality), and that the risk of overall mortality decreased for patients with liver transplantation relative to surgical resection as disease severity increased (T1: aHR = 0.53; T2: aHR = 0.47; T3 and T4: aHR = 0.33). CONCLUSION: The findings indicated that transplantation has survival advantages compared with resection in treating patients with HCC, particularly in later stage disease.