TY - JOUR
T1 - Evaluating the benefit of surgical resection for hepatocellular carcinoma with multifocality or intrahepatic vascular invasion
AU - Kothari, Anai N.
AU - Massarweh, Nader N.
AU - Flitcroft, Madelyn A.
AU - Newhook, Timothy
AU - Tzeng, Ching Wei D.
AU - Chun, Yun S.
AU - Kaseb, Ahmed O.
AU - Vauthey, Jean Nicolas
AU - Tran Cao, Hop S.
N1 - Publisher Copyright:
© 2023 International Hepato-Pancreato-Biliary Association Inc.
PY - 2023/7
Y1 - 2023/7
N2 - Background: The role of hepatectomy for hepatocellular carcinoma (HCC) with multifocality or intrahepatic vascular involvement remains ill-defined. Our objective was to evaluate benefits of surgical resection for patients with these high-risk features. Methods: The National Cancer Database was used to identify HCC patients with vascular involvement and/or multifocality (T2/T3, N-/M−) from 2011 to 2015. Propensity score matching (k-nearest neighbors, no replacement, 1:1) grouped patients by treatment: surgical resection versus non-surgical modalities. Groups were matched using patient, clinical, and liver-specific characteristics. Median overall survival (OS) was calculated using Kaplan–Meier, and adjusted analyses were performed using shared frailty models. Results: 14,557 patients met inclusion criteria, including 1892 (9.4%) treated with surgical resection. Median cohort OS was 20.5 months. After adjustment, surgical resection was associated with survival advantage compared to non-surgical treatment (37.8 versus 15.7 months, log-rank P < .001; adjusted hazard ratio 0.49, 95% confidence interval, 0.45–0.54). Patients with minimal comorbidity, unifocal disease, and age <54 had highest probability of survival one year post-surgery. Conclusions: Surgical resection is associated with a survival advantage in HCC with multifocality and/or intrahepatic vascular involvement. The presence of these features should not contraindicate consideration of hepatectomy in suitable surgical candidates.
AB - Background: The role of hepatectomy for hepatocellular carcinoma (HCC) with multifocality or intrahepatic vascular involvement remains ill-defined. Our objective was to evaluate benefits of surgical resection for patients with these high-risk features. Methods: The National Cancer Database was used to identify HCC patients with vascular involvement and/or multifocality (T2/T3, N-/M−) from 2011 to 2015. Propensity score matching (k-nearest neighbors, no replacement, 1:1) grouped patients by treatment: surgical resection versus non-surgical modalities. Groups were matched using patient, clinical, and liver-specific characteristics. Median overall survival (OS) was calculated using Kaplan–Meier, and adjusted analyses were performed using shared frailty models. Results: 14,557 patients met inclusion criteria, including 1892 (9.4%) treated with surgical resection. Median cohort OS was 20.5 months. After adjustment, surgical resection was associated with survival advantage compared to non-surgical treatment (37.8 versus 15.7 months, log-rank P < .001; adjusted hazard ratio 0.49, 95% confidence interval, 0.45–0.54). Patients with minimal comorbidity, unifocal disease, and age <54 had highest probability of survival one year post-surgery. Conclusions: Surgical resection is associated with a survival advantage in HCC with multifocality and/or intrahepatic vascular involvement. The presence of these features should not contraindicate consideration of hepatectomy in suitable surgical candidates.
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U2 - 10.1016/j.hpb.2023.03.002
DO - 10.1016/j.hpb.2023.03.002
M3 - Article
C2 - 37085394
AN - SCOPUS:85152942521
SN - 1365-182X
VL - 25
SP - 758
EP - 765
JO - HPB
JF - HPB
IS - 7
ER -