Liver transplant tied to better survival than systemic therapy only in nonmetastatic HCC

In patients with nonmetastatic hepatocellular carcinoma (HCC), treatment with upfront liver transplant or liver transplant with bridge systemic therapy results in significantly better improvements in overall survival (OS) compared with systemic therapy only, according to a study.

Of the 29,691 patients with nonmetastatic HCC included in the analysis, 25,122 (84.6 percent) received systemic therapy only, 2,513 (8.5 percent) had bridge systemic therapy followed by liver transplant, and 2,056 (6.9 percent) underwent upfront liver transplant without systemic therapy bridge.

Patients treated with bridge systemic therapy followed by liver transplant and those treated with upfront liver transplant had a significantly better OS than those who received systemic therapy only (mean OS: 101.9 and 98.2 vs 39.4 months; p<0.001 for all).

No significant difference in OS was noted between patients treated with bridge systemic therapy followed by liver transplant and those treated with upfront liver transplant (mean OS: 101.9 vs 98.2 months; p=0.187).

Multivariate analysis revealed the association of older age (hazard ratio [HR], 1.011, 95 percent confidence interval [CI], 1.010–1.013; p<0.001), male sex (HR, 1.048, 95 percent CI, 1.014–1.084; p=0.006), White race (HR, 1.055, 95 percent CI, 1.012–1.099; p=0.011), no insurance status (HR, 1.155, 95 percent CI, 1.079–1.237; p<0.001), clinical T4 stage (HR, 1.366, 95 percent CI, 1.257–1.483; p<0.001), and systemic therapy alone (p<0.001) with worse OS.

“While our study confirms the survival benefit of liver transplant among patients with nonmetastatic HCC, these results raise the importance of proceeding with liver transplant after intra-arterial and/or systemic treatments in patients who are not initially eligible for or missed the opportunity of upfront liver transplant,” the investigators said.