Surgery for hepatocellular carcinoma: does it improve survival?

Area of Science:

• Oncology
• Surgical Oncology
• Hepatobiliary Surgery

Background:

• Increasing incidence and mortality of hepatocellular carcinoma (HCC) in the United States.
• Uncertainty regarding the population-level survival benefit of surgical intervention for HCC.
• Need to compare survival outcomes between surgical and non-surgical HCC patients with similar characteristics.

Purpose of the Study:

• To evaluate the association between surgical resection and survival outcomes in patients with hepatocellular carcinoma (HCC).
• To compare survival rates in HCC patients who received surgery versus those who did not, controlling for tumor size and health status.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify HCC patients.
• Included patients with surgically resectable disease based on expert guidelines, excluding those with contraindications.
• Performed survival analysis and multivariate Cox regression to identify predictors of improved survival.

Main Results:

• Of 4008 diagnosed HCC patients (1988-1998), 417 were candidates for resection (mean age 63.6 years, mean tumor size 3.3 cm).
• Five-year overall survival was 33% with surgery (mean survival 47.1 months) versus 7% without surgery (mean survival 17.9 months) (P <.001).
• Surgery was a significant predictor of improved survival (P <.001), reducing the death rate by 55% after adjusting for covariates.

Conclusions:

• Surgical therapy is associated with significantly improved survival for patients with unifocal, nonmetastatic HCC tumors less than 5 cm.
• Highlights the importance of providing access to potentially curative surgery for eligible HCC patients.
• Suggests efforts to ensure high-quality care and surgical opportunities for appropriate resectable HCC patients.