Skye C Mayo1, Michael N Mavros2, Hari Nathan3, David Cosgrove4, Joseph M Herman5, Ihab Kamel6, Robert A Anders7, Timothy M Pawlik8. 1. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD. 2. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Department of Surgery, MedStar Washington Hospital Center, Washington, DC. 3. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY. 4. Department of Medical Oncology, Johns Hopkins Hospital, Baltimore, MD. 5. Department of Radiology, Johns Hopkins Hospital, Baltimore, MD. 6. Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD. 7. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD. 8. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD. Electronic address: tpawlik1@jhmi.edu.
Abstract
BACKGROUND: Surgery remains the only potentially curative option for patients with hepatocellular carcinoma (HCC) and fibrolamellar carcinoma (FLC). We sought to investigate the differences over time in surgically managed FLC compared with conventional HCC using population-based data. STUDY DESIGN: Using SEER data, we identified 7,225 patients with surgically managed FLC or HCC from 1986 to 2008. We examined differences in clinicopathologic and surgical factors associated with long-term survival. RESULTS: Of the 7,225 patients, the majority had HCC (n = 7,135; 99%) vs FLC (n = 90; 1%). Patients with FLC were younger (25 years vs 59 years) and more often were women (44% vs 27%) than patients with HCC (both p < 0.001). Regional disease was more common among patients with FLC (42.2%) vs patients with HCC (22.1%) (p < 0.001). More than one-third of patients with FLC (36.9%) were operatively managed with a hemihepatectomy compared with patients with HCC, who were more often managed with a liver transplant (p < 0.001). On univariable analysis, there was a marked difference in overall survival, with patients with FLC surviving a median of 75 months vs 43 months for HCC (hazard ratio [HR]: 0.59; p = 0.001). There was a marked difference in survival when patients were stratified by localized (FLC, 78 months vs HCC, 49 months; p = 0.012) vs regional disease (FLC, 46 months vs HCC, 23 months; p = 0.002. CONCLUSIONS: Patients with FLC have many clinicopathologic features that are different from those of patients with HCC, including younger age and female sex. Despite a higher likelihood of advanced disease at the time of diagnosis, surgically treated FLC patients had better long-term outcomes than patients with conventional HCC.
BACKGROUND: Surgery remains the only potentially curative option for patients with hepatocellular carcinoma (HCC) and fibrolamellar carcinoma (FLC). We sought to investigate the differences over time in surgically managed FLC compared with conventional HCC using population-based data. STUDY DESIGN: Using SEER data, we identified 7,225 patients with surgically managed FLC or HCC from 1986 to 2008. We examined differences in clinicopathologic and surgical factors associated with long-term survival. RESULTS: Of the 7,225 patients, the majority had HCC (n = 7,135; 99%) vs FLC (n = 90; 1%). Patients with FLC were younger (25 years vs 59 years) and more often were women (44% vs 27%) than patients with HCC (both p < 0.001). Regional disease was more common among patients with FLC (42.2%) vs patients with HCC (22.1%) (p < 0.001). More than one-third of patients with FLC (36.9%) were operatively managed with a hemihepatectomy compared with patients with HCC, who were more often managed with a liver transplant (p < 0.001). On univariable analysis, there was a marked difference in overall survival, with patients with FLC surviving a median of 75 months vs 43 months for HCC (hazard ratio [HR]: 0.59; p = 0.001). There was a marked difference in survival when patients were stratified by localized (FLC, 78 months vs HCC, 49 months; p = 0.012) vs regional disease (FLC, 46 months vs HCC, 23 months; p = 0.002. CONCLUSIONS:Patients with FLC have many clinicopathologic features that are different from those of patients with HCC, including younger age and female sex. Despite a higher likelihood of advanced disease at the time of diagnosis, surgically treated FLC patients had better long-term outcomes than patients with conventional HCC.
Authors: Skye C Mayo; Andrew D Shore; Hari Nathan; Barish H Edil; Kenzo Hirose; Robert A Anders; Christopher L Wolfgang; Richard D Schulick; Michael A Choti; Timothy M Pawlik Journal: HPB (Oxford) Date: 2011-05-18 Impact factor: 3.647
Authors: V Maniaci; B R Davidson; K Rolles; A P Dhillon; A Hackshaw; R H Begent; T Meyer Journal: Eur J Surg Oncol Date: 2009-01-13 Impact factor: 4.424
Authors: Celina S Ang; R Katie Kelley; Michael A Choti; David P Cosgrove; Joanne F Chou; David Klimstra; Michael S Torbenson; Linda Ferrell; Timothy M Pawlik; Yuman Fong; Eileen M O'Reilly; Jennifer Ma; Joseph McGuire; Gandhi P Vallarapu; Ann Griffin; Francesco Stipa; Marinela Capanu; Ronald P Dematteo; Alan P Venook; Ghassan K Abou-Alfa Journal: Gastrointest Cancer Res Date: 2013-01
Authors: Francesco Stipa; Sam S Yoon; Kui Hin Liau; Yuman Fong; William R Jarnagin; Michael D'Angelica; G Abou-Alfa; Leslie H Blumgart; Ronald P DeMatteo Journal: Cancer Date: 2006-03-15 Impact factor: 6.860
Authors: Bolanle Asiyanbola; David Chang; Ana Luiza Gleisner; Hari Nathan; Michael A Choti; Richard D Schulick; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2008-02-12 Impact factor: 3.452
Authors: David G Darcy; Marcus M Malek; Rachel Kobos; David S Klimstra; Ronald DeMatteo; Michael P La Quaglia Journal: J Pediatr Surg Date: 2014-12-10 Impact factor: 2.545
Authors: Timothy A Dinh; Alan F Utria; Kevin C Barry; Rosanna Ma; Ghassan K Abou-Alfa; John D Gordan; Elizabeth M Jaffee; John D Scott; Jessica Zucman-Rossi; Allison F O'Neill; Mark E Furth; Praveen Sethupathy Journal: Nat Rev Gastroenterol Hepatol Date: 2022-02-21 Impact factor: 73.082
Authors: Kevin M Riggle; Kimberly J Riehle; Heidi L Kenerson; Rigney Turnham; Miwako K Homma; Machiko Kazami; Bret Samelson; Renay Bauer; G Stanley McKnight; John D Scott; Raymond S Yeung Journal: Pediatr Res Date: 2016-03-08 Impact factor: 3.756