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Survival and prognostic factors after transplantation, resection and ablation in a national cohort of early hepatocellular carcinoma

Eilard, Malin S. ; Naredi, Peter LU ; Helmersson, Madeleine ; Hemmingsson, Oskar ; Isaksson, Bengt ; Lindell, Gert LU ; Sandström, Per ; Strömberg, Cecilia and Rizell, Magnus (2021) In HPB 23(3). p.394-403
Abstract

Background: In patients with early hepatocellular cancer (HCC) and preserved liver function, the choice between transplantation, resection and ablation and which factors to consider is not obvious and guidelines differ. In this national cohort study, we aimed to compare posttreatment survival in patients fulfilling predefined criteria, and to analyse preoperative risk factors that could influence decision. Methods: We used data from HCC-patients registered with primary transplantation, resection or ablation 2008–2016 in the SweLiv-registry. In Child A-subgroups, 18–75 years, we compared survival after transplantation or resection, with different tumour criteria; either corresponding to our transplantation criteria (N = 257) or stricter... (More)

Background: In patients with early hepatocellular cancer (HCC) and preserved liver function, the choice between transplantation, resection and ablation and which factors to consider is not obvious and guidelines differ. In this national cohort study, we aimed to compare posttreatment survival in patients fulfilling predefined criteria, and to analyse preoperative risk factors that could influence decision. Methods: We used data from HCC-patients registered with primary transplantation, resection or ablation 2008–2016 in the SweLiv-registry. In Child A-subgroups, 18–75 years, we compared survival after transplantation or resection, with different tumour criteria; either corresponding to our transplantation criteria (N = 257) or stricter with single tumours ≤50 mm (N = 159). A subgroup with single tumours ≤30 mm, compared all three treatments (N = 193). Results: We included 1022 HCC-patients; transplantation n = 223, resection n = 438, ablation n = 361. In the transplant criteria subgroup, differences in five-year survival, adjusted for age and gender, were not significant, with 71.2% (CI 62.3–81.3) after transplantation (n = 109) and 63.5% (CI 54.9–73.5) after resection (n = 148). Good liver function (Child 5 vs. 6, Albumin ≥36), increased the risk after transplantation, but decreased the risk after resection and ablation. Conclusion: Even within Child A, detailed liver function assessment is important before treatment decision, and for stratifying survival comparisons.

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author
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publishing date
type
Contribution to journal
publication status
published
subject
in
HPB
volume
23
issue
3
pages
394 - 403
publisher
Elsevier
external identifiers
  • pmid:32792306
  • scopus:85089258292
ISSN
1365-182X
DOI
10.1016/j.hpb.2020.07.010
language
English
LU publication?
no
id
e2ba0646-5f5b-4387-b0ba-eff909071516
date added to LUP
2020-08-20 09:37:31
date last changed
2024-09-19 04:29:17
@article{e2ba0646-5f5b-4387-b0ba-eff909071516,
  abstract     = {{<p>Background: In patients with early hepatocellular cancer (HCC) and preserved liver function, the choice between transplantation, resection and ablation and which factors to consider is not obvious and guidelines differ. In this national cohort study, we aimed to compare posttreatment survival in patients fulfilling predefined criteria, and to analyse preoperative risk factors that could influence decision. Methods: We used data from HCC-patients registered with primary transplantation, resection or ablation 2008–2016 in the SweLiv-registry. In Child A-subgroups, 18–75 years, we compared survival after transplantation or resection, with different tumour criteria; either corresponding to our transplantation criteria (N = 257) or stricter with single tumours ≤50 mm (N = 159). A subgroup with single tumours ≤30 mm, compared all three treatments (N = 193). Results: We included 1022 HCC-patients; transplantation n = 223, resection n = 438, ablation n = 361. In the transplant criteria subgroup, differences in five-year survival, adjusted for age and gender, were not significant, with 71.2% (CI 62.3–81.3) after transplantation (n = 109) and 63.5% (CI 54.9–73.5) after resection (n = 148). Good liver function (Child 5 vs. 6, Albumin ≥36), increased the risk after transplantation, but decreased the risk after resection and ablation. Conclusion: Even within Child A, detailed liver function assessment is important before treatment decision, and for stratifying survival comparisons.</p>}},
  author       = {{Eilard, Malin S. and Naredi, Peter and Helmersson, Madeleine and Hemmingsson, Oskar and Isaksson, Bengt and Lindell, Gert and Sandström, Per and Strömberg, Cecilia and Rizell, Magnus}},
  issn         = {{1365-182X}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{394--403}},
  publisher    = {{Elsevier}},
  series       = {{HPB}},
  title        = {{Survival and prognostic factors after transplantation, resection and ablation in a national cohort of early hepatocellular carcinoma}},
  url          = {{http://dx.doi.org/10.1016/j.hpb.2020.07.010}},
  doi          = {{10.1016/j.hpb.2020.07.010}},
  volume       = {{23}},
  year         = {{2021}},
}