Rajalakshmi Govalan1, Marie Lauzon2,3, Michael Luu2,3, Joseph C Ahn4, Kambiz Kosari2,5,6, Tsuyoshi Todo2,5,6, Irene K Kim5,6, Mazen Noureddin1,5,7, Alexander Kuo1,5,7, Ayoub S Walid1,5,7, Vinay Sundaram1,5,7, Shelly C Lu1,2, Lewis R Roberts4, Amit G Singal8,9, Julie K Heimbach10,11, Vatche G Agopian12, Nicholas Nissen2,5,6, Ju Dong Yang1,2,5,7. 1. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA. 2. Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. 3. Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA. 4. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. 5. Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA. 6. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA. 7. Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA. 8. Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA. 9. Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA. 10. Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA. 11. Liver Transplant Program, Mayo Clinic, Rochester, Minnesota, USA. 12. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Abstract
INTRODUCTION: Small studies from outside of the USA suggest excellent outcomes after surgical resection for hepatocellular carcinoma (HCC) with vascular invasion. The study aims to (1) compare overall survival after surgical resection and systemic therapy among patients with HCC and vascular invasion and (2) determine factors associated with receipt of surgical resection in a US population. METHODS: HCC patients with AJCC clinical TNM stage 7th T3BN0M0 diagnosed between 2010 and 2017 from the National Cancer Database were analyzed. Cox and logistic regression analyses identified factors associated with overall survival and receipt of surgical resection. RESULTS: Of 11,259 patients with T3BN0M0 HCC, 325 (2.9%) and 4,268 (37.9%) received surgical resection and systemic therapy, respectively. In multivariable analysis, surgical resection was associated with improved survival compared to systemic therapy (adjusted hazard ratio: 0.496, 95% confidence interval: 0.426-0.578) with a median survival of 21.4 and 8.1 months, respectively. Superiority of surgical resection was observed in noncirrhotic and cirrhotic subgroups and propensity score matching and inverse probability of treatment weighting adjusted analysis. Asians were more likely to receive surgical resection, whereas Charlson comorbidity ≥3, elevated alpha-fetoprotein, smaller tumor size, care in a community cancer program, and the South or West region were associated with a lower likelihood of surgical resection. CONCLUSION: HCC patients with vascular invasion may benefit from surgical resection compared to systemic therapies. Demographic and clinical features of HCC patients and region and type of treating facility were associated with surgical resection versus systemic treatment.
INTRODUCTION: Small studies from outside of the USA suggest excellent outcomes after surgical resection for hepatocellular carcinoma (HCC) with vascular invasion. The study aims to (1) compare overall survival after surgical resection and systemic therapy among patients with HCC and vascular invasion and (2) determine factors associated with receipt of surgical resection in a US population. METHODS: HCC patients with AJCC clinical TNM stage 7th T3BN0M0 diagnosed between 2010 and 2017 from the National Cancer Database were analyzed. Cox and logistic regression analyses identified factors associated with overall survival and receipt of surgical resection. RESULTS: Of 11,259 patients with T3BN0M0 HCC, 325 (2.9%) and 4,268 (37.9%) received surgical resection and systemic therapy, respectively. In multivariable analysis, surgical resection was associated with improved survival compared to systemic therapy (adjusted hazard ratio: 0.496, 95% confidence interval: 0.426-0.578) with a median survival of 21.4 and 8.1 months, respectively. Superiority of surgical resection was observed in noncirrhotic and cirrhotic subgroups and propensity score matching and inverse probability of treatment weighting adjusted analysis. Asians were more likely to receive surgical resection, whereas Charlson comorbidity ≥3, elevated alpha-fetoprotein, smaller tumor size, care in a community cancer program, and the South or West region were associated with a lower likelihood of surgical resection. CONCLUSION: HCC patients with vascular invasion may benefit from surgical resection compared to systemic therapies. Demographic and clinical features of HCC patients and region and type of treating facility were associated with surgical resection versus systemic treatment.
Authors: Jordi Bruix; Jean-Luc Raoul; Morris Sherman; Vincenzo Mazzaferro; Luigi Bolondi; Antonio Craxi; Peter R Galle; Armando Santoro; Michel Beaugrand; Angelo Sangiovanni; Camillo Porta; Guido Gerken; Jorge A Marrero; Andrea Nadel; Michael Shan; Marius Moscovici; Dimitris Voliotis; Josep M Llovet Journal: J Hepatol Date: 2012-06-19 Impact factor: 25.083
Authors: Richard S Finn; Shukui Qin; Masafumi Ikeda; Peter R Galle; Michel Ducreux; Tae-You Kim; Masatoshi Kudo; Valeriy Breder; Philippe Merle; Ahmed O Kaseb; Daneng Li; Wendy Verret; Derek-Zhen Xu; Sairy Hernandez; Juan Liu; Chen Huang; Sohail Mulla; Yulei Wang; Ho Yeong Lim; Andrew X Zhu; Ann-Lii Cheng Journal: N Engl J Med Date: 2020-05-14 Impact factor: 91.245