Faculty Collaboration Database

Ablation for hepatocellular carcinoma: validating the 3-cm breakpoint. Ann Surg Oncol 2013 Oct;20(11):3591-5

Date

05/31/2013

Pubmed ID

23720072

DOI

10.1245/s10434-013-3031-5

Scopus ID

2-s2.0-84883762865 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

BACKGROUND: Although many previous studies on local ablation outcomes for hepatocellular carcinoma (HCC) have dichotomized tumor size with a 3-cm cutoff to determine prognostic significance, a growing number of reports describe excellent outcomes for larger tumors. To address the logic of this 3-cm cutoff beyond small single-center experiences, we stratified patients by 1-cm tumor size intervals and hypothesized that disease-specific survival (DSS) would not vary significantly between adjacent groups.

METHODS: Patients treated with local ablation for T1 HCC (≤8 cm) were identified from the surveillance, epidemiology, and end results database (2004-2008). Log-rank tests and multivariable Cox proportional hazards models were used to compare DSS curves of adjacent study groups.

RESULTS: There were 1,083 patients included in the study (26 % female, median age: 62 years). The 3-year DSS was significantly lower in patients with 3- to 4-cm tumors compared to 2- to 3-cm tumors (58 vs. 72 %, p = 0.002). In adjusted models, DSS did not vary significantly between any size intervals up to 3 cm. Patients with 3- to 4-cm tumors, however, had a poorer prognosis compared with patients with 2- to 3-cm tumors (hazard ratio: 1.6, 95 % confidence interval: 1.18-2.18, p = 0.002). DSS also fell when tumor size increased from 5-6 to 6-7 cm (53 vs. 21 %, 0.006).

CONCLUSIONS: This study emphasizes the 3-cm size, and possibly the 6-cm size, as informative predictive thresholds when ablating HCC, because variability of DSS occurred specifically at these tumor sizes. Future research in this field should either adopt a 3-cm breakpoint or provide evidence for alternative thresholds.

Author List

Groeschl RT, Gamblin TC, 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

Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular
Catheter Ablation
Female
Follow-Up Studies
Humans
Liver Neoplasms
Male
Middle Aged
Neoplasm Staging
Prognosis
Retrospective Studies
Risk Factors
SEER Program
Survival Rate
Tumor Burden
Young Adult