Liver transplantation should be offered to patients with small solitary hepatocellular carcinoma and a positive serum alpha fetoprotein rather than resection.

BACKGROUND: As debate continues as to what surgical modality should be offered to patients with hepatocellular carcinoma, the authors submit that serum α-fetoprotein (AFP) is an important variable to consider. METHODS: Using the Surveillance, Epidemiology and End Results database, patients with solitary tumors within the Milan criteria were further stratified into 2 groups, those who underwent orthotopic liver transplantation (OLT) and those who underwent segmentectomy, lobectomy, or extended lobectomy (resection). Patients were further grouped according to serum AFP status (negative or positive). Relative survival was retrospectively evaluated for 3 years using the log-rank test. RESULTS: In the AFP-negative group, resection (n = 165) offered equivalent survival compared with OLT (n = 116); 3-year survival was 73.8% and 81.6%, respectively (P = .245). In the AFP-positive group, 3-year survival for resection (n = 200) was 59%, while survival was 75.3% for OLT (n = 181), which showed a clear survival advantage (P = .001). CONCLUSIONS: The results of this study demonstrate that patients with solitary hepatocellular carcinoma lesions within the Milan criteria and AFP-positive status should not undergo resection but rather be offered OLT.