INTRODUCTION: We investigated the role of operative therapy in non-cirrhotic patients who developed metastatic hepatocellular carcinoma (HCC). METHODS: This retrospective cohort study included consecutive non-cirrhotic patients with metastatic HCC after a prior hepatectomy treated between 1990 and 2009. Patients were stratified by operative therapy (resection, ablation, transcatheter therapy). Kaplan-Meier analyses with log-rank comparisons tested effects of operative therapy on overall survival (OS) and progression-free survival (PFS). RESULTS: Of 195 non-cirrhotic patients treated for HCC during the study period, 98 [median age 65, interquartile range (IQR) 53-71; 55 % male] subsequently developed metastatic HCC (55 intrahepatic only). Median time to development of metastases after the index operation was 10 months (IQR 5-20 months); median number of metastases was 3 (IQR 2-7). Half of these patients (n = 50) underwent operative treatment of metastases; 20 (40 %) underwent metastasectomy, 18 (36 %) ablation, and 12 (24 %) transcatheter therapy. Operative therapy was associated with improved OS (p < 0.001). Resection or ablation was associated with improved PFS and OS compared to transcatheter therapy (all p ≤ 0.006). Nine patients (seven resection, two ablation) are disease free at a median of 50 months (IQR 24-80 months) posttreatment. CONCLUSIONS: Resection and ablation are associated with an improved PFS and long-term OS and should be considered in select patients with metastatic HCC.
INTRODUCTION: We investigated the role of operative therapy in non-cirrhotic patients who developed metastatic hepatocellular carcinoma (HCC). METHODS: This retrospective cohort study included consecutive non-cirrhotic patients with metastatic HCC after a prior hepatectomy treated between 1990 and 2009. Patients were stratified by operative therapy (resection, ablation, transcatheter therapy). Kaplan-Meier analyses with log-rank comparisons tested effects of operative therapy on overall survival (OS) and progression-free survival (PFS). RESULTS: Of 195 non-cirrhotic patients treated for HCC during the study period, 98 [median age 65, interquartile range (IQR) 53-71; 55 % male] subsequently developed metastatic HCC (55 intrahepatic only). Median time to development of metastases after the index operation was 10 months (IQR 5-20 months); median number of metastases was 3 (IQR 2-7). Half of these patients (n = 50) underwent operative treatment of metastases; 20 (40 %) underwent metastasectomy, 18 (36 %) ablation, and 12 (24 %) transcatheter therapy. Operative therapy was associated with improved OS (p < 0.001). Resection or ablation was associated with improved PFS and OS compared to transcatheter therapy (all p ≤ 0.006). Nine patients (seven resection, two ablation) are disease free at a median of 50 months (IQR 24-80 months) posttreatment. CONCLUSIONS: Resection and ablation are associated with an improved PFS and long-term OS and should be considered in select patients with metastatic HCC.
Authors: R L Smoot; D M Nagorney; V S Chandan; F G Que; C D Schleck; W S Harmsen; M L Kendrick Journal: Br J Surg Date: 2011-01-31 Impact factor: 6.939
Authors: William Jarnagin; William C Chapman; Steven Curley; Michael D'Angelica; Charles Rosen; Elijah Dixon; David Nagorney Journal: HPB (Oxford) Date: 2010-06 Impact factor: 3.647
Authors: Seung Min Jung; Jeong Won Jang; Chan Ran You; Sun Hong Yoo; Jung Hyun Kwon; Si Hyun Bae; Jong Young Choi; Seung Kew Yoon; Kyu Won Chung; Chul Seung Kay; Hyun Suk Jung Journal: J Gastroenterol Hepatol Date: 2012-04 Impact factor: 4.029
Authors: Josep M Llovet; Sergio Ricci; Vincenzo Mazzaferro; Philip Hilgard; Edward Gane; Jean-Frédéric Blanc; Andre Cosme de Oliveira; Armando Santoro; Jean-Luc Raoul; Alejandro Forner; Myron Schwartz; Camillo Porta; Stefan Zeuzem; Luigi Bolondi; Tim F Greten; Peter R Galle; Jean-François Seitz; Ivan Borbath; Dieter Häussinger; Tom Giannaris; Minghua Shan; Marius Moscovici; Dimitris Voliotis; Jordi Bruix Journal: N Engl J Med Date: 2008-07-24 Impact factor: 91.245
Authors: Wolfgang Sieghart; Matthias Pinter; Michael Reisegger; Christian Müller; Ahmed Ba-Ssalamah; Johannes Lammer; Markus Peck-Radosavljevic Journal: Eur Radiol Date: 2012-01-04 Impact factor: 7.034