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The chances of hepatic resection curing hepatocellular carcinoma

Published:November 29, 2019DOI:https://doi.org/10.1016/j.jhep.2019.11.016

      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

      Keywords

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