Surgical resection significantly promotes the overall survival of patients with hepatocellular carcinoma: a propensity score matching analysis

Yaw-Sen Chen; Pei-Min Hsieh; Hung-Yu Lin; Chao-Ming Hung; Gin-Ho Lo; Yao-Chun Hsu; I-Cheng Lu; Chih-Yuan Lee; Tsung-Chin Wu; Jen-Hao Yeh; Pojen Hsiao; Yu-Chan Li; Ya-Chin Wang; Kun-Chou Hsieh; Chih-Wen Lin

doi:10.1186/s12876-021-01807-4

Surgical resection significantly promotes the overall survival of patients with hepatocellular carcinoma: a propensity score matching analysis

BMC Gastroenterol. 2021 May 14;21(1):220. doi: 10.1186/s12876-021-01807-4.

Authors

Yaw-Sen Chen^#^{1

2}, Pei-Min Hsieh^#², Hung-Yu Lin^#^{1

2}, Chao-Ming Hung^{1

2}, Gin-Ho Lo^{3

1}, Yao-Chun Hsu^{3

1}, I-Cheng Lu^{4

1}, Chih-Yuan Lee⁵, Tsung-Chin Wu^{6

1}, Jen-Hao Yeh^{6

3

1}, Pojen Hsiao^{6

1}, Yu-Chan Li¹, Ya-Chin Wang^{6

1}, Kun-Chou Hsieh², Chih-Wen Lin^{7

8

9

10

11

12}

Affiliations

¹ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC.
² Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC.
³ Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC.
⁴ Health Examination Center, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC.
⁵ Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan, ROC.
⁶ Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung, 807, Taiwan, ROC.
⁷ Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung, 807, Taiwan, ROC. lincw66@gmail.com.
⁸ Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC. lincw66@gmail.com.
⁹ Health Examination Center, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan, ROC. lincw66@gmail.com.
¹⁰ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 824, Taiwan, ROC. lincw66@gmail.com.
¹¹ School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan, ROC. lincw66@gmail.com.
¹² Research Center for Traditional Chinese Medicine, China Medical University Hospital, Taichung, 404, Taiwan, ROC. lincw66@gmail.com.

^# Contributed equally.

Abstract

Background: The benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepatocellular carcinoma (HCC) remain unclear. We investigated the risk factors of overall survival (OS) and survival benefits of SR over nonsurgical treatments in patients with HCC of various BCLC stages.

Methods: Overall, 2316 HCC patients were included, and their clinicopathological data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed.

Results: In total, 66 (2.8%), 865 (37.4%), 575 (24.8%) and 870 (35.0%) patients had BCLC stage 0, A, B, and C disease, respectively. Furthermore, 1302 (56.2%) of all patients, and 37 (56.9%), 472 (54.6%), 313 (54.4%) and 480 (59.3%) of patients with BCLC stage 0, A, B, and C disease, respectively, died. The median follow-up duration time was 20 (range 0-96) months for the total cohort and was subdivided into 52 (8-96), 32 (1-96), 19 (0-84), and 12 (0-79) months for BCLC stages 0, A, B, and C cohorts, respectively. The risk factors for OS were (1) SR and cirrhosis; (2) SR, cirrhosis, and Child-Pugh (C-P) class; (3) SR, hepatitis B virus (HBV) infection, and C-P class; and (4) SR, HBV infection, and C-P class for the BCLC stage 0, A, B, and C cohorts, respectively. Compared to non-SR treatment, SR resulted in significantly higher survival rates in all cohorts. The 5-year OS rates for SR vs. non-SR were 44.0% versus 28.7%, 72.2% versus 42.6%, 42.6% versus 36.2, 44.6% versus 23.5%, and 41.4% versus 15.3% (all P values < 0.05) in the total and BCLC stage 0, A, B, and C cohorts, respectively. After PSM, SR resulted in significantly higher survival rates compared to non-SR treatment in various BCLC stages.

Conclusions: SR conferred significant survival benefits to patients with HCC of various BCLC stages and should be considered a recommended treatment for select HCC patients, especially patients with BCLC stage B and C disease.

Keywords: Hepatitis B virus; Hepatocellular carcinoma; Overall survival; Prognosis; Surgical resection.

MeSH terms

Carcinoma, Hepatocellular* / pathology
Carcinoma, Hepatocellular* / surgery
Hepatectomy
Humans
Liver Neoplasms* / pathology
Liver Neoplasms* / surgery
Neoplasm Staging
Propensity Score
Retrospective Studies
Treatment Outcome

Abstract

MeSH terms

Grants and funding