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

Research output: Contribution to journalArticle

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 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.

Details

Authors
  • Malin S. Eilard
  • Peter Naredi
  • Madeleine Helmersson
  • Oskar Hemmingsson
  • Bengt Isaksson
  • Gert Lindell
  • Per Sandström
  • Cecilia Strömberg
  • Magnus Rizell
External organisations
  • Sahlgrenska University Hospital
  • Umeå University
  • Uppsala University
  • Skåne University Hospital
  • Linköping University
  • Karolinska University Hospital
  • University of Gothenburg
  • Regional Cancer Center Western Sweden
  • Östergötland County Council
  • Karolinska Institutet
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology
Original languageEnglish
JournalHPB
Publication statusE-pub ahead of print - 2020 Dec 10
Publication categoryResearch
Peer-reviewedYes
Externally publishedYes