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)   23 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

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