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Survival and prognostic factors after transplantation, resection and ablation in a national cohort of early hepatocellular carcinoma
Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Regional Cancer Center West, Western Sweden Health Care Region, Gothenburg, Sweden.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.ORCID iD: 0000-0003-1732-168X
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2021 (English)In: HPB, ISSN 1365-182X, E-ISSN 1477-2574, Vol. 23, no 3, p. 394-403Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2021. Vol. 23, no 3, p. 394-403
National Category
Surgery
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URN: urn:nbn:se:umu:diva-184277DOI: 10.1016/j.hpb.2020.07.010ISI: 000632022800007PubMedID: 32792306Scopus ID: 2-s2.0-85089258292OAI: oai:DiVA.org:umu-184277DiVA, id: diva2:1564108
Available from: 2021-06-11 Created: 2021-06-11 Last updated: 2021-09-22Bibliographically approved

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