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Comparison of Surgical Resection and Systemic Treatment for Hepatocellular Carcinoma with Vascular Invasion: National Cancer Database Analysis
- Source :
- Liver Cancer, Pp 1-12 (2021), Liver Cancer, Liver cancer, vol 10, iss 5
- Publication Year :
- 2021
- Publisher :
- S. Karger AG, 2021.
-
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.
- Subjects :
- Liver Cancer
medicine.medical_specialty
Hepatocellular carcinoma
Population
Systemic therapy
Rare Diseases
Medicine
Stage (cooking)
vascular invasion
education
RC254-282
Cancer
education.field_of_study
Hepatology
business.industry
Liver Disease
Hazard ratio
Evaluation of treatments and therapeutic interventions
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
surgical resection
hepatocellular carcinoma
Prognosis
medicine.disease
Comorbidity
Surgery
Vascular invasion
Oncology
Surgical resection
6.1 Pharmaceuticals
Propensity score matching
Patient Safety
prognosis
Digestive Diseases
business
6.4 Surgery
Research Article
Subjects
Details
- ISSN :
- 16645553 and 22351795
- Volume :
- 10
- Database :
- OpenAIRE
- Journal :
- Liver Cancer
- Accession number :
- edsair.doi.dedup.....facbf26d2e786f5caa94aa9c53da5469