肝臟切除和肝臟移植被視為對於早期肝癌的治癒性療法，但是對於究竟選擇何者可獲得較好預後卻仍有爭議。本研究以符合米蘭規約的早期肝癌患者分別經手術切除或是肝臟移植後的存活分析做一比較。並且進一步找出影響臨床預後的危險因子。自2006年1月至2013年1月，分別有65及184位符合米蘭規約的肝癌病人接受肝臟移植或是手術切除。此兩組病人的總存活率及無病存活率亦分別加以比較之。更進一步地，為了瞭解病人肝臟功能的不同以及活體肝臟移植對於病人預後的影響，也執行了兩種次族群的分析，分別為良好肝功能與肝硬化患者進行手術切除與肝臟移植的預後比較，以及活體肝臟移植和手術切除後的病人預後比較。本研究發現，早期肝癌患者中，其接受肝臟移植的無病存活率比接受手術切除要來的高，並且呈現有統計學上的差異，但是兩組病人的總存活率則未到達統計學上的意義，但是在術後三年後開始，可觀察到肝移植的患者明顯有較高的總存活率，並且隨時序而擴大差異。對於預後的危險因子分析方面，真正導致病人有較低的無病存活率的因素則是多發性腫瘤、血管有腫瘤侵犯以及接受手術切除而非移植。影響總存活率的因素則是肝臟的硬化、多發性腫瘤和血管有腫瘤侵犯。結論上來說，儘管腫瘤本身的因素影響著臨床預後，但是由統計的結果顯示，肝臟移植，包括活體肝臟移植，應為符合米蘭規約的早期肝癌患者較佳的治療首選。肝臟切除的角色則在於以術後病理檢體協助辨識出較差的預後因子的有無，俾使臨床醫師能做出更佳醫療處置。
Liver resection (LR) and liver transplantation (LT) are curative treatments for early hepatocellular carcinoma (HCC), although their performance remains debated. We compared the survival of patients with HCC conforming to the Milan criteria (MC) after LT and LR and analyzed factors affecting clinical outcomes. Between January 2006 and January 2013, 65 and 184 patients received LT and LR for HCCs fulfilling the MC, respectively. Overall survival (OS) and disease-free survival (DFS) rates were compared between the two groups. To investigate effects of liver function and living donor liver transplantation (LDLT) on survival, two subgroup analyses were performed and associations with OS and DFS were examined. We found that OS rates were higher after LT than after LR since 3 years postoperatively. DFS rates were significantly better after LT than after LR. Performance of LR, vascular invasion, and tumor multiplicity were associated with poor DFS, and factors affecting OS included the presence of vascular invasions, liver cirrhosis, and tumor multiplicity. In conclusion, despite of the effects of tumor characteristics on clinical outcomes, LT, including LDLT, should be considered the treatment of choice for patients with HCCs who met the MC. The role of LR is to identify poor prognostic factors through pathological examination.
