Journal article
Liver resection is superior to tumor ablation in patients with multifocal hepatocellular carcinoma
Journal of surgical oncology, Vol.129(6), pp.1113-1120
04/23/2024
DOI: 10.1002/jso.27599
PMID: 38333997
Appears in UI Libraries Support Open Access
Abstract
Introduction: The management of T2 multifocal hepatocellular carcinoma (MHCC) is controversial, and the comparative impact of liver resection (LR) versus tumor ablation (TA) on survival continues to be debated. The aim of our study was to examine short- and long-term survival for LR and TA in a nationally representative cohort. We hypothesized that patients who underwent LR would have improved survival. Methods: We utilized the National Cancer Database (2004-2015) to identify patients diagnosed with non-metastatic T2 MHCC. Kaplan-Meier survival curves were generated to compare 10-year overall survival (OS) between LR and TA patients. Kaplan-Meier analysis with stratification was also performed based on lymphovascular invasion, resection margin status, and Charlson-Deyo score. Cox proportional hazard models were used in multivariable analyses. Results: A total of 1225 patients met the inclusion criteria. 991 patients received LR, and 234 received TA. The majority of patients were male, White, and older than >= 60 years old. Clinicodemographic characteristics were generally similar between LR and TA patients. Among patients who underwent LR, 84% had negative margins, and 17% had lymphovascular invasion. Mortality at 30 days was significantly higher among LR patients compared to TA patients (5.4% vs 0.0%, p < 0.001), with those having a Charlson-Deyo score >= 2 facing the highest risk at 7.3%. Nevertheless, 10-year OS for the LR cohort was 27.5% (95% confidence interval [CI]: 24.4%-30.8%) versus 14.7% (95% CI: 9.8%-20.7%, p < 0.001) for TA patients. In stratified analysis, survival benefit was statistically significant only among those with negative resection margin, no lymphovascular invasion, and Charlson-Deyo score <= 1. In multivariable Cox analysis, LR was independently associated with improved survival compared to TA (hazard ratio: 0.80; 95% CI = 0.67-0.95). Conclusion: LR poses a higher long-term survival benefit than TA. Prospective studies are warranted to confirm these findings. Although our study patients are a highly selected group of multifocal T2 patients, it gives us a good insight into the fact that LR provides better outcomes if a transplant option is unavailable.
Details
- Title: Subtitle
- Liver resection is superior to tumor ablation in patients with multifocal hepatocellular carcinoma
- Creators
- Hanna Kakish - University Hospitals of ClevelandMohammed O. Suraju - University of IowaErik S. Davis - University of Iowa Hospitals and ClinicsAbhinav Seth - Univ Iowa Hosp & Clin, Dept Surg, Iowa City, IA USAYong K. Kwon - University of WashingtonHassan Aziz - University of Iowa, Surgery
- Resource Type
- Journal article
- Publication Details
- Journal of surgical oncology, Vol.129(6), pp.1113-1120
- Publisher
- Wiley
- DOI
- 10.1002/jso.27599
- PMID
- 38333997
- ISSN
- 0022-4790
- eISSN
- 1096-9098
- Number of pages
- 8
- Language
- English
- Electronic publication date
- 02/09/2024
- Date published
- 04/23/2024
- Academic Unit
- Surgery
- Record Identifier
- 9984585953602771
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