Abstract
Background
The role of hepatectomy for hepatocellular carcinoma (HCC) with multifocality or intrahepatic
vascular involvement remains ill-defined. Our objective was to evaluate potential
benefits of surgical resection for patients with these high-risk features.
Methods
The National Cancer Database was used to identify HCC patients with vascular involvement
and/or multifocality (T2/T3, N-/M−) diagnosed from 2011 to 2015. Propensity score
matching (k-nearest neighbors, no replacement, 1:1) evenly grouped patients by treatment:
surgical resection versus non-surgical modalities. Groups were matched using patient,
clinical, and liver-specific characteristics. Median overall survival (OS) was calculated
using Kaplan–Meier, and adjusted analyses were performed using shared frailty models.
Results
14,557 patients met inclusion criteria, including 1892 (9.4%) treated with surgical
resection. Median cohort OS was 20.5 months. Following propensity matching and adjusted
analysis, surgical resection was associated with survival advantage compared to non-surgical
treatment (37.8 versus 15.7 months, log-rank P < .001; adjusted hazard ratio 0.49,
95% confidence interval, 0.45–0.54). Patients with minimal comorbidity, unifocal disease,
and age <54 had highest probability of survival one year post-surgery.
Conclusions
Surgical resection is associated with a survival advantage in HCC with multifocality
and/or intrahepatic vascular involvement. The presence of these features should not
contraindicate consideration of hepatectomy in suitable surgical candidates.
Graphical abstract
Graphical Abstract
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to HPBAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global epidemiology of hepatocellular carcinoma (HCC epidemiology).J Gastrointest Cancer. 2017; 48: 238-240
- The epidemiology of hepatocellular carcinoma in the USA.Curr Gastroenterol Rep. 2019; 21: 17
- Multidisciplinary approach is associated with improved survival of hepatocellular carcinoma patients.PLoS One. 2019; 14e0210730
- The importance of a multidisciplinary approach to hepatocellular carcinoma.J Multidiscip Healthc. 2017; 10: 95-100
- Intermediate stage hepatocellular carcinoma: a summary review.J Hepatocell Carcinoma. 2019; 6: 105-117
- Treatment of intermediate-stage hepatocellular carcinoma.Nat Rev Clin Oncol. 2014; 11: 525-535
- Significance of hepatectomy for AJCC/UICC T3 hepatocellular carcinoma.Anticancer Res. 2015; 35: 2921-2928
- Surgical resection versus transarterial chemoembolization for intermediate stage hepatocellular carcinoma (BCLC-B): an unsolved question.Hepatology. 2019; 69: 923
- NCCN guidelines insights: hepatobiliary cancers, version 1.2017.J Natl Compr Cancer Netw. 2017; 15: 563-573
- Using the national cancer Database for outcomes research: a review.JAMA Oncol. 2017; 3: 1722-1728
- ROCS: receiver operating characteristic surface for class-skewed high-throughput data.PLoS One. 2012; 7e40598
- Package ‘rpart’. 2015 (cran. ma. ic. ac. uk/web/packages/rpart/rpart. pdf)Date accessed: April 20, 2016
- Utilizing machine learning for pre- and postoperative assessment of patients undergoing resection for BCLC-0, A and B hepatocellular carcinoma: implications for resection beyond the BCLC guidelines.Ann Surg Oncol. 2020; 27: 866-874
- BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update.J Hepatol. 2022; 76: 681-693
- The benefit of liver transplant beyond Milan criteria: an analysis using the National Cancer Database.Surgery. 2022; 172: 1823-1828
- Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American association for the study of liver diseases.Hepatology. 2018; 68: 723-750
- Liver resection for multiple hepatocellular carcinomas: a Japanese nationwide survey.Ann Surg. 2020; 272: 145-154
- Hepatic resection associated with good survival for selected patients with intermediate and advanced-stage hepatocellular carcinoma.Ann Surg. 2014; 260: 329-340
- Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion.J Hepatol. 2016; 65: 938-943
- Liver resection for hepatocellular carcinoma associated with hepatic vein invasion: a Japanese nationwide survey.Hepatology. 2017; 66: 510-517
- Effect of diameter and number of hepatocellular carcinomas on survival after resection, transarterial chemoembolization, and ablation.Am J Gastroenterol. 2021; 116: 1698-1708
- Comparison of hepatocellular carcinoma in Eastern versus Western populations.Cancer. 2016; 122: 3430-3446
- Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma.Gastroenterology. 2014; 146 (700.e3): 1691
- Multiple hepatocellular carcinomas: liver resection or transcatheter arterial chemoembolization?.Hepatobiliary Surg Nutr. 2019; 8: 519-521
- Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan Criteria: a RCT.J Hepatol. 2014; 61: 82-88
- Factors affecting outcome in liver resection.HPB. 2005; 7: 226-230
- Facility type is associated with margin status and overall survival of patients with resected intrahepatic cholangiocarcinoma.Ann Surg Oncol. 2019; 26: 4091-4099
- Model for end-stage liver disease (MELD) and allocation of donor livers.Gastroenterology. 2003; 124: 91-96
Article info
Publication history
Published online: March 06, 2023
Accepted:
March 3,
2023
Received:
September 6,
2022
Publication stage
In Press Uncorrected ProofFootnotes
This was presented as a virtual oral presentation at HPBA 2020 World Congress.
Identification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
