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Surgery for Hepatocellular Carcinoma: Does It Improve Survival?

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Abstract

Background: The incidence and mortality of hepatocellular carcinoma (HCC) are increasing in the United States. Whether surgery is associated with improved survival at the population level is relatively unknown. To address this question, we used a population-based cancer registry to compare survival outcomes between patients receiving and not receiving surgery with similar tumor sizes and health status.

Methods: By using the Surveillance, Epidemiology, and End Results database, we identified HCC patients who had surgically resectable disease as defined by published expert guidelines. After excluding patients with contraindications to surgery, we performed both survival analysis and Cox regression to identify predictors of improved survival.

Results: Of the 4008 patients diagnosed with HCC between 1988 and 1998, 417 were candidates for surgical resection. The mean age was 63.6 years; mean tumor size was 3.3 cm. The 5-year overall survival with surgery was 33% with a mean of 47.1 months; without surgery, the 5-year overall survival was 7% with a mean of 17.9 months (P < .001). In the multivariate Cox regression, surgery was significantly associated with improved survival (P < .001). Specifically, patients who received surgery had a 55% decreased rate of death compared with patients who did not have surgery, even after controlling for tumor size, age, sex, and race.

Conclusions: This study shows that surgical therapy is associated with improved survival in patients with unifocal, nonmetastatic HCC tumors <5 cm. If this is confirmed in future studies, efforts should be made to ensure that appropriate patients with resectable HCC receive high-quality care, as well as the opportunity for potentially curative surgery.

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Authors and Affiliations

  1. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California

    Jerome H. Liu MD, MSHS, Pauline W. Chen MD, Steven M. Asch MD, MPH, Ronald W. Busuttil MD, PhD & Clifford Y. Ko MD, MSHS

  2. Department of Surgery, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California

    Jerome H. Liu MD, MSHS & Clifford Y. Ko MD, MSHS

  3. Division of General Internal Medicine, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California

    Jerome H. Liu MD, MSHS & Steven M. Asch MD, MPH

  4. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California

    Steven M. Asch MD, MPH

  5. 11301 West Olympic Boulevard, #648, Los Angeles, CA, 90064

    Jerome H. Liu MD, MSHS

Authors
  1. Jerome H. Liu MD, MSHS
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  2. Pauline W. Chen MD
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  3. Steven M. Asch MD, MPH
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  4. Ronald W. Busuttil MD, PhD
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  5. Clifford Y. Ko MD, MSHS
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Correspondence to Jerome H. Liu MD, MSHS.

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Liu, J.H., Chen, P.W., Asch, S.M. et al. Surgery for Hepatocellular Carcinoma: Does It Improve Survival?. Ann Surg Oncol 11, 298–303 (2004). https://doi.org/10.1245/ASO.2004.03.042

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  • DOI: https://doi.org/10.1245/ASO.2004.03.042

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