Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Liver transplantation is theoretically the best option for HCC. However, it is limited by a shortage of graft availability. This study aims to analyze the HCC patients who underwent hepatectomy, but had a high recurrence risk.

We collected patients by retrograde review from 1983 to 2005 in Chang Gung Medical hospital, Taipei. A total of 1595 patients underwent hepatectomy due to HCC. 840 patients whose tumors were within UCSF criteria were enrolled into this study.

659 patients were male (78.5%) and 181 were female (21.5%); 583 were disease free survival (DFS)<5 years (69.4%) and 257 were DFS>5 years (30.6%). According to univariate analysis, detectable pre-operative factors related to a poor 5-year disease-free survival rate were gender, AST34, ALT36, ALP94, ALB3.5, AFP15, cirrhosis, and tumor size. In multivariate analysis gender, AST>34, albumin3.5, AFP>15, and tumor size>5 showed prognostic value upon univariate analysis.

Liver transplantation and hepatectomy for HCC within UCSF criteria are good therapeutic strategies. The benefit of primary liver transplantation or salvage liver transplantation is still controversial. In Taiwan, a liver graft shortage area, it is important to select suitable cases to carry out liver transplantation. HCC within UCSF criteria, but with high recurrence risk factors such as male, AST>34, albumin3.5, AFP>15, and tumor size>5cm could be an indicator for primary liver transplantation rather than hepatectomy.

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