Pinna, AD, Yang, T, Mazzaferro, V, De Carlis, Luciano, Zhou, Jian, Roayaie, Sasan, Shen, Feng, Sposito,, Carlo, Cescon, Matteo, Di Sandro, Stefano et al (show 3 more authors)
(2018)
Liver Transplantation and Hepatic Resection can Achieve Cure for Hepatocellular Carcinoma.
Annals of Surgery, 268 (5).
pp. 868-875.
Text
Manuscript.docx - Author Accepted Manuscript Download (51kB) |
Abstract
Objective: The aim of this study was to estimate probabilities of achieving the statistical cure from hepatocellular carcinoma (HCC) with hepatic resection (HR) and liver transplantation (LT). Background: Statistical cure occurs when the mortality of a specific population returns to values of that of general population. Resection and transplantation are considered potentially curative therapies for HCC, but their effect on the residual entire life-expectancy has never been investigated. Methods: Data from 3286 HCC patients treated with LT (n = 1218) or HR (n = 2068) were used to estimate statistical cure. Disease-free survival (DFS) was the primary survival measure to estimate cure fractions through a nonmixture model. Overall survival (OS) was a secondary measure. In both, patients were matched with general population by age, sex, year, and race/ethnicity. Cure variations after LT were also adjusted for different waiting-list drop-outs. Results: Considering DFS, the cure fraction after LT was 74.1% and after HR was 24.1% (effect size >0.8). LT outperformed HR within all transplant criteria considered (effect size >0.8), especially for multiple tumors (>0.9) and even in presence of a drop-out up to 20% (>0.5). Considering OS, the cure fraction after LT marginally increased to 75.8%, and after that HR increased to 40.5%. The effect size of LT over HR in terms of cure decreased for oligonodular tumors (<0.5), became small for drop-out up to ~20% (<0.2), and negligible for single tumors <5 cm (~0.1). Conclusion: As other malignancies, statistical cure can occur for HCC, primarily with LT and secondarily with HR, depending on waiting-list capabilities and efficacy of tumor recurrence therapies after resection
Item Type: | Article |
---|---|
Uncontrolled Keywords: | cirrhosis, disease-free survival, general population, hepatic resection, hepatocellular carcinoma, liver transplant, overall survival, partial hepatectomy, statistical cure, survival benefit, tumor recurrence, waiting-list removal |
Depositing User: | Symplectic Admin |
Date Deposited: | 01 May 2020 10:37 |
Last Modified: | 19 Jan 2023 00:57 |
Related URLs: | |
URI: | https://livrepository.liverpool.ac.uk/id/eprint/3034117 |