Diamantis I Tsilimigras1, Fabio Bagante2, Dimitrios Moris1, Katiuscha Merath1, Anghela Z Paredes1, Kota Sahara1, Francesca Ratti3, Hugo P Marques4, Olivier Soubrane5, Vincent Lam6, George A Poultsides7, Irinel Popescu8, Sorin Alexandrescu8, Guillaume Martel9, Aklile Workneh9, Alfredo Guglielmi10, Tom Hugh11, Luca Aldrighetti3, Itaru Endo12, Timothy M Pawlik13. 1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. 2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Surgery, University of Verona, Italy. 3. Department of Surgery, Ospedale San Raffaele, Milano, Italy. 4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal. 5. Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France. 6. Department of Surgery, Westmead Hospital, Sydney, Australia. 7. Department of Surgery, Stanford University, CA. 8. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania. 9. Department of Surgery, University of Ottawa, ON, Canada. 10. Department of Surgery, University of Verona, Italy. 11. Department of Surgery, The University of Sydney, School of Medicine, Australia. 12. Yokohama City University School of Medicine, Japan. 13. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: tim.pawlik@osumc.edu.
Abstract
BACKGROUND: Surgery is considered the only potentially curative treatment option for patients with hepatocellular carcinoma. However, the chance that patients will eventually be "cured" after liver resection for hepatocellular carcinoma remains ill defined. METHODS: Patients who underwent curative-intent hepatectomy for hepatocellular carcinoma between 1998 and 2017 were identified using an international multi-institutional database. A nonmixture cure model was used with disease-free survival as a primary measure to estimate cure fractions after matching patients with the general population by age, race, and sex. RESULTS: Among 1,010 patients, the median and 5-year disease-free survival were 2.8 years and 36.6%, respectively. The probability of being cured after hepatocellular carcinoma resection was 42.2% and the median time to cure was 3.35 years. The multivariable cure model revealed preoperative alpha-fetoprotein level, tumor size, tumor number, and margin status as independent predictors of cure. The cure fraction for patients with an alpha-fetoprotein level ≤ 10 ng/mL, largest tumor size ≤5 cm, ≤3 nodules, and R0 resection was 61.6%. In contrast, patients who had all 4 unfavorable prognostic factors (ie, alpha-fetoprotein >11 ng/mL, nodules ≥4, size >5cm, R1 resection) had a cure fraction of 15.8%. Although the probability of cure was 47.6% among Barcelona Clinic Liver Cancer-A patients, patients undergoing resection for Barcelona Clinic Liver Cancer-B hepatocellular carcinoma had a 37.6% cure fraction. Only alpha-fetoprotein levels predicted the probability of cure among Barcelona Clinic Liver Cancer-B patients. CONCLUSION: Roughly 4 in 10 patients could be considered "cured" after liver resection for hepatocellular carcinoma. Although cure was achieved more often after resection for Barcelona Clinic Liver Cancer-A hepatocellular carcinoma, surgery still provided a reasonable probability of cure among select patients with Barcelona Clinic Liver Cancer-B hepatocellular carcinoma.
BACKGROUND: Surgery is considered the only potentially curative treatment option for patients with hepatocellular carcinoma. However, the chance that patients will eventually be "cured" after liver resection for hepatocellular carcinoma remains ill defined. METHODS:Patients who underwent curative-intent hepatectomy for hepatocellular carcinoma between 1998 and 2017 were identified using an international multi-institutional database. A nonmixture cure model was used with disease-free survival as a primary measure to estimate cure fractions after matching patients with the general population by age, race, and sex. RESULTS: Among 1,010 patients, the median and 5-year disease-free survival were 2.8 years and 36.6%, respectively. The probability of being cured after hepatocellular carcinoma resection was 42.2% and the median time to cure was 3.35 years. The multivariable cure model revealed preoperative alpha-fetoprotein level, tumor size, tumor number, and margin status as independent predictors of cure. The cure fraction for patients with an alpha-fetoprotein level ≤ 10 ng/mL, largest tumor size ≤5 cm, ≤3 nodules, and R0 resection was 61.6%. In contrast, patients who had all 4 unfavorable prognostic factors (ie, alpha-fetoprotein >11 ng/mL, nodules ≥4, size >5cm, R1 resection) had a cure fraction of 15.8%. Although the probability of cure was 47.6% among Barcelona Clinic Liver Cancer-A patients, patients undergoing resection for Barcelona Clinic Liver Cancer-B hepatocellular carcinoma had a 37.6% cure fraction. Only alpha-fetoprotein levels predicted the probability of cure among Barcelona Clinic Liver Cancer-B patients. CONCLUSION: Roughly 4 in 10 patients could be considered "cured" after liver resection for hepatocellular carcinoma. Although cure was achieved more often after resection for Barcelona Clinic Liver Cancer-A hepatocellular carcinoma, surgery still provided a reasonable probability of cure among select patients with Barcelona Clinic Liver Cancer-B hepatocellular carcinoma.
Authors: Diamantis I Tsilimigras; Rittal Mehta; Dimitrios Moris; Kota Sahara; Fabio Bagante; Anghela Z Paredes; Amika Moro; Alfredo Guglielmi; Luca Aldrighetti; Matthew Weiss; Todd W Bauer; Sorin Alexandrescu; George A Poultsides; Shishir K Maithel; Hugo P Marques; Guillaume Martel; Carlo Pulitano; Feng Shen; Olivier Soubrane; Bas Groot Koerkamp; Itaru Endo; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2019-11-14 Impact factor: 5.344
Authors: Dimitrios Giannis; Sara Morsy; Georgios Geropoulos; Stepan M Esagian; Georgios S Sioutas; Dimitrios Moris Journal: In Vivo Date: 2021 Jan-Feb Impact factor: 2.406
Authors: Dimitrios Moris; Brian I Shaw; Cecilia Ong; Ashton Connor; Mariya L Samoylova; Samuel J Kesseli; Nader Abraham; Jared Gloria; Robin Schmitz; Zachary W Fitch; Bryan M Clary; Andrew S Barbas Journal: Hepatobiliary Surg Nutr Date: 2021-06 Impact factor: 7.293