Sasan Roayaie1, Ghalib Jibara2, Parissa Tabrizian3, Joong-Won Park4, Jijin Yang5, Lunan Yan6, Myron Schwartz3, Guohong Han7, Francesco Izzo8, Mishan Chen9, Jean-Frédéric Blanc10, Philip Johnson11, Masatoshi Kudo12, Lewis R Roberts13, Morris Sherman14. 1. North Shore-LIJ Health Systems, Lenox Hill Hospital, New York, NY. 2. Brookdale's Medical Center, Department of Urology, Brooklyn, NY. 3. Mount Sinai Medical Center, New York, NY. 4. Center for Liver Cancer, National Cancer Center, Goyang, Korea. 5. Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China. 6. Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China. 7. Department of Hepatology and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China. 8. Hepatobiliary Unit, National Cancer Institute of Naples, G. Pascale Foundation, Naples, Italy. 9. Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China. 10. Hepatology and Digestive Oncology Unit, Hôpital Saint-André, Bordeaux, France. 11. University of Liverpool, Liverpool, United Kingdom. 12. Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan. 13. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN. 14. University of Toronto and University Health Network, Toronto, Ontario, Canada.
Abstract
UNLABELLED: Current guidelines recommend surgical resection as the primary treatment for a single hepatocellular cancer (HCC) with Child's A cirrhosis, normal serum bilirubin, and no clinically significant portal hypertension. We determined how frequently guidelines were followed and whether straying from them impacted survival. BRIDGE is a multiregional cohort study including HCC patients diagnosed between January 1, 2005 and June 30, 2011. A total of 8,656 patients from 20 sites were classified into four groups: (A) 718 ideal resection candidates who were resected; (B) 144 ideal resection candidates who were not resected; (C) 1,624 nonideal resection candidates who were resected; and (D) 6,170 nonideal resection candidates who were not resected. Median follow-up was 27 months. Log-rank and Cox's regression analyses were conducted to determine differences between groups and variables associated with survival. Multivariate analysis of all ideal candidates for resection (A+B) revealed a higher risk of mortality with treatments other than resection. For all resected patients (A+C), portal hypertension and bilirubin >1 mg/dL were not associated with mortality. For all patients who were not ideal candidates for resection (C+D), resection was associated with better survival, compared to embolization and "other" treatments, but was inferior to ablation and transplantation. CONCLUSIONS: The majority of patients undergoing resection would not be considered ideal candidates based on current guidelines. Not resecting ideal candidates was associated with higher mortality. The study suggests that selection criteria for resection may be modestly expanded without compromising outcomes, and that some nonideal candidates may still potentially benefit from resection over other treatment modalities.
UNLABELLED: Current guidelines recommend surgical resection as the primary treatment for a single hepatocellular cancer (HCC) with Child's A cirrhosis, normal serum bilirubin, and no clinically significant portal hypertension. We determined how frequently guidelines were followed and whether straying from them impacted survival. BRIDGE is a multiregional cohort study including HCCpatients diagnosed between January 1, 2005 and June 30, 2011. A total of 8,656 patients from 20 sites were classified into four groups: (A) 718 ideal resection candidates who were resected; (B) 144 ideal resection candidates who were not resected; (C) 1,624 nonideal resection candidates who were resected; and (D) 6,170 nonideal resection candidates who were not resected. Median follow-up was 27 months. Log-rank and Cox's regression analyses were conducted to determine differences between groups and variables associated with survival. Multivariate analysis of all ideal candidates for resection (A+B) revealed a higher risk of mortality with treatments other than resection. For all resected patients (A+C), portal hypertension and bilirubin >1 mg/dL were not associated with mortality. For all patients who were not ideal candidates for resection (C+D), resection was associated with better survival, compared to embolization and "other" treatments, but was inferior to ablation and transplantation. CONCLUSIONS: The majority of patients undergoing resection would not be considered ideal candidates based on current guidelines. Not resecting ideal candidates was associated with higher mortality. The study suggests that selection criteria for resection may be modestly expanded without compromising outcomes, and that some nonideal candidates may still potentially benefit from resection over other treatment modalities.
Authors: Giovanni Battista Levi Sandri; Gabriele Spoletini; Giovanni Vennarecci; Elisa Francone; Mohammed Abu Hilal; Giuseppe Maria Ettorre Journal: Surg Endosc Date: 2018-05-16 Impact factor: 4.584
Authors: Saleh A Alqahtani; Faisal M Sanai; Ashwaq Alolayan; Faisal Abaalkhail; Hamad Alsuhaibani; Mazen Hassanain; Waleed Alhazzani; Abdullah Alsuhaibani; Abdullah Algarni; Alejandro Forner; Richard S Finn; Waleed K Al-Hamoudi Journal: Saudi J Gastroenterol Date: 2020-10 Impact factor: 2.485