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External radiation or ablation for solitary hepatocellular carcinoma: A survival analysis of the SEER database. J Surg Oncol 2017 Sep;116(3):307-312

Date

05/04/2017

Pubmed ID

28464313

DOI

10.1002/jso.24661

Scopus ID

2-s2.0-85018739094   1 Citation

Abstract

BACKGROUND AND OBJECTIVES: Hepatocellular carcinoma (HCC) patients are often not candidates for resection. This study hypothesized that external beam radiation (XRT) could be equally effective compared to ablation therapy (AT) for selected HCC patients.

METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify HCC patients (2004-2012) undergoing XRT or AT for solitary HCC lesions. Propensity score modeling was utilized to adjust for baseline characteristics.

RESULTS: Propensity matching identified 784 patients: 157 (20%) XRT and 627 (80%) AT. Median OS for XRT and AT was 22, and 32 months (P < 0.001), respectively. AT demonstrated improved OS for tumors 3-5 cm (30 vs 16 m, P < 0.001) and >5 cm (25 vs 9 m, P < 0.001). Similar survival was found in patients with tumor size <3 cm (37 vs 47 m P = 0.508). Following multivariate analyses, XRT was associated with an increased hazard ratio (HR = 1.64, P < 0.001). Elevated AFP at diagnosis (HR = 1.54, P = 0.001) and tumor size >3 were identified as negative predictors of survival.

CONCLUSIONS: Similar survival for solitary HCC lesions <3 cm exists between XRT and AT. However, AT demonstrates improved survival rates compared to XRT for lesions >3 cm. This 3 cm reference point may serve as a valuable metric to guide treatment decisions and future investigations.

Author List

Berger NG, Tanious MN, Hammad AY, Miura JT, Mogal H, Clarke CN, Christians KK, Tsai S, Gamblin TC

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Callisia N. Clarke MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Thomas Clark Gamblin MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Harveshp Mogal MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Susan Tsai MD Associate Professor in the Surgery department at Medical College of Wisconsin




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

Aged
Carcinoma, Hepatocellular
Catheter Ablation
Female
Hepatectomy
Humans
Liver Neoplasms
Male
Middle Aged
Propensity Score
Retrospective Studies
SEER Program
Survival Analysis
Survival Rate
United States
jenkins-FCD Prod-399 190a069c593fb5498b7fcd942f44b7bc9cdc7ea1