Abstract

We sought to evaluate the impact of liver transplantation (LT) programs on the prognosis of hepatocellular carcinoma (HCC) patients who underwent liver resection (LR) and non-curative intent treatment.LT programs have an array of resources and services that would positively affect the prognosis of patients with HCC.Patients who underwent LT, LR, radiotherapy (RT), or chemotherapy (CTx) for HCC between 2004 to 2018 were included from the National Cancer Database. Institutions with LT programs were defined as those that performed one or more LT for at least 5 years. Centers were stratified by hospital volume. The impact of LT programs was assessed after propensity score matching to achieve covariate balance.A total of 71,735 patients were identified, of which 7,997 received LT (11.1%), 12,683 LR (17.7%), 15,675 RT (21.9%), and 35,380 CTx (49.3%). Among a total of 1,267 distinct institutions, 94 (7.4%) were categorized as LT programs. Designation as a LT program was also associated with a high-volume of LR and non-curative intent treatment (both P<0.001). After propensity score matching, LT programs were associated with better survival among LR and non-curative intent treatment patients. Although hospital volume was also associated with improved prognosis, LT programs were associated with additional survival benefit in non-curative intent treatment. On the other hand, no such benefit was noted in patients who underwent LR.The presence of an LT program was associated with a higher volume of LR and non-curative intent treatment. Furthermore, designation as a LT program has a "halo effect" on the prognosis of patients undergoing RT/ CTx that goes beyond the procedure-volume effect.

View details for DOI 10.1097/SLA.0000000000005849

View details for PubMedID 36994716