LAUSR

BACKGROUND Multifocal hepatocellular carcinoma (HCC) differs biologically and immunologically from single-nodule HCC. Asian and European guidelines consider liver transplantation (LT) and partial hepatectomy (PH)) as effective for T2 multifocal HCC, with preference towards LT, but few US studies compare these treatments directly. This propensity-score based observational study uses an established national cancer outcomes registry to compare overall survival in patients undergoing PH and LT for multifocal HCC. STUDY DESIGN Data from the 2020 National Cancer Database was obtained on patients who underwent LT or PH for multi-focal stage 2 HCC within Milan criteria and without vascular invasion. Propensity-score matching and Cox-regression analysis was applied to evaluate overall survival in an observational cohort balanced by age, sex, treatment facility type, treatment year, prothrombin time, alpha-fetoprotein, comorbidity burden, liver fibrosis severity, and pre-treatment creatinine and bilirubin levels. RESULTS Of 21,248 T2 HCC cases identified, 6744 had multi-focal tumors with largest tumor diameter < 3cm without major vascular invasion, with 1267 and 181 having underwent LT and PH, respectively. Propensity-score matched Cox-regression analysis associated LT with a hazard ratio of 0.39 (95% CI 0.30 - 0.50) relative to PH. Landmark analyses to account for a longer interval to LT demonstrated survival benefits of similar magnitude. CONCLUSIONS While early-stage HCC can be effectively treated with either LT or PH, propensity-score matched analysis comparatively shows a survival benefit for LT in patients with multifocal HCC who are within Milan Criteria.