Highlights
- •DFS in resected patients with HCC was compared to DFS in those with chronic liver disease w/o HCC, and the general population.
- •Resected patients with HCC could achieve the same life expectancy as those with chronic liver disease in 26.3% of cases.
- •Resection enables patients with HCC to achieve the same life expectancy as the general population in 17.1% of cases.
- •Patients resected in more recent years had higher cure probabilities, probably due to effective antiviral therapies.
Background & Aims
The popular sense of the word “cure” implies that a patient treated for a specific
disease will return to have the same life expectancy as if he/she had never had the
disease. In analytic terms, it translates into the concept of statistical cure which
occurs when a group of patients returns to having similar mortality to a reference
population. The aim of this study was to assess the probability of being cured from
hepatocellular carcinoma (HCC) by hepatic resection.
Methods
Data from 2,523 patients undergoing resection for HCC were used to fit statistical
cure models, to compare disease-free survival (DFS) after surgery to the survival
expected for patients with chronic hepatitis and/or cirrhosis and the general population,
matched by sex, age, race/ethnicity and year of diagnosis.
Results
The probability of resection enabling patients with HCC to achieve the same life expectancy
as those with chronic hepatitis and/or cirrhosis was 26.3%. The conditional probability
of achieving this result was time-dependent, requiring about 8.9 years to be accomplished
with 95% certainty. Considering the general population as a reference, the cure fraction
decreased to 17.1%. Uncured patients had a median DFS of 1.5 years. In multivariable
analysis, patient's age and the risk of early HCC recurrence (within 2 years) were
independent determinants of the chance of cure (p <0.001). The chances of being cured ranged between 36.0% for individuals at low risk
of early recurrence to approximately 3.6% for those at high risk.
Conclusion
Estimates of the chance of being cured of HCC by resection showed that cure is achievable,
and its likelihood increases with the passing of recurrence-free time. The data presented
herein can be used to inform decision making and to provide patients with accurate
information.
Lay summary
Data from 2,523 patients who underwent resection for hepatocellular carcinoma were
used to estimate the probability that resection would enable treated patients to achieve
the same life expectancy as patients with chronic hepatitis and/or cirrhosis, and
the general population. Herein, the cure model suggests that in patients with hepatocellular
carcinoma, resection can enable patients to achieve the same life expectancy as those
with chronic liver disease in 26.3% of cases and as the general population in 17.1%
of cases.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: November 29, 2019
Accepted:
November 19,
2019
Received in revised form:
November 4,
2019
Received:
April 5,
2019
Identification
Copyright
© 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
