Risk of Long-Term Survival After Hepatic Resection for Hepatocellular and Intrahepatic Cholangiocarcinoma:
Jung Min Lee1, Sung Jae Kim2, Tae Yoo3
1Department of Surgery, Hallym University School of Medicine, Hwaseong, Korea.
Background:
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are the two major types of primary liver cancer, accounting for approximately 70% and 15% of all cases, respectively. South Korea remains a high-incidence region for both malignancies. Despite advances in surgical and imaging techniques, long-term survival outcomes and their changing trends over time have not been fully evaluated in population-based studies. This study aims to analyze survival rates and their influencing factors among patients with HCC and ICC who underwent hepatic resection in Korea.
Methods:
Using the Korea Central Cancer Registry, we analyzed data from 43,537 patients who underwent hepatectomy between 2004 and 2018. Patients were categorized by time period (2004-2008, 2009-2013, 2014-2018), and 5-year survival rates were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazards models identified prognostic factors associated with survival.
Results:
A total of 36,380 patients with HCC and 7,157 with ICC underwent liver resection. Both cancers showed a male predominance, more pronounced in HCC. Major hepatectomy was frequent, particularly in ICC, which was associated with longer hospital stays, higher medical costs than HCC. Over time, the proportion of patients residing in metropolitan areas declined, more than half of surgeries continued to be performed there, indicating persistent geographic disparity between residence and treatment location. Surgeries at high-volume centers increased, hospital stays shortened, and 5-year survival improved in HCC but remained unchanged in ICC. Multivariable analysis identified male sex, advanced age, major hepatectomy, surgical region as independent predictors of poorer survival, with low income adversely affecting survival only in HCC.
Conclusion:
Postoperative survival following hepatectomy has improved for HCC but remains unchanged for ICC. Better outcomes were observed for surgeries performed in metropolitan areas, likely reflecting differences in institutional experience and resources. These findings highlight persistent disparities in treatment outcomes and underscore the need for regionally balanced healthcare resources and further studies to refine prognostic determinants in primary liver cancers surgery.