Faculty Collaboration Database

Surgical resection in hepatocellular carcinoma patients with minimal background fibrosis: a strategy in the era of organ shortage. Ann Surg Oncol 2013 Jun;20(6):2043-8

Date

01/22/2013

Pubmed ID

23334253

DOI

10.1245/s10434-012-2857-6

Scopus ID

2-s2.0-84878220099 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

BACKGROUND: Surgical therapies for hepatocellular carcinoma (HCC) represent the potentially curative approaches and provide patients the greatest survival advantage. We sought to examine the outcomes of patients with HCC treated with surgical resection, transplantation, and local ablation.

METHODS: The Surveillance, Epidemiology, and End Results database was queried for all patients with nonmetastatic HCC from 2004 to 2007 who underwent local ablation (LA), segmental resection (SR), hemihepatectomy or extended resection (ER), or transplantation (TP).

RESULTS: Of 16,209 patients with HCC, 3,989 (24.6 %) met criteria for inclusion and received therapies: 1,550 LA (39 %), 703 SR (18 %), 619 ER (16 %), and 1,117 TP (28 %). AFP was elevated in 69 % (2,026 of 2,921), and fibrosis grade 0-4 was noted in 32 % (368 of 1,156). The 3-year survival by procedure was 34 % (LA), 50 % (SR), 54 % (ER), and 74 % (TP), p = .001. In patients with minimal fibrosis, 1-year survival for patients undergoing resection was similar to TP (85 vs. 92 %, p = .346), but greater than LA (69 %, p = .001).

DISCUSSION: Survival after surgical resection for HCC patients without extensive fibrosis appears to be superior to ablation and non-inferior to transplantation. In an era of organ shortage, transplantation may be better reserved for patients with cirrhosis and/or unresectable disease.

Author List

Groeschl RT, Clark Gamblin T, Turaga KK

Author

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Ablation Techniques
Aged
Carcinoma, Hepatocellular
Female
Hepatectomy
Humans
Kaplan-Meier Estimate
Liver Cirrhosis
Liver Neoplasms
Liver Transplantation
Male
Middle Aged
Proportional Hazards Models
Retrospective Studies
SEER Program
Severity of Illness Index
Survival Rate
alpha-Fetoproteins