Evaluating the benefit of surgical resection for hepatocellular carcinoma with multifocality or intrahepatic vascular invasion

• Published in: HPB (Oxford, England) Vol. 25; no. 7; pp. 758 - 765
• Main Authors: Kothari, Anai N., Massarweh, Nader N., Flitcroft, Madelyn A., Newhook, Timothy, Tzeng, Ching-Wei D., Chun, Yun S., Kaseb, Ahmed O., Vauthey, Jean-Nicolas, Tran Cao, Hop S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2023
• Subjects: Carcinoma, Hepatocellular - pathology; Hepatectomy - adverse effects; Humans; Liver Neoplasms - pathology; Propensity Score; Retrospective Studies; Treatment Outcome
• ISSN: 1365-182X; 1477-2574; 1477-2574
• DOI: 10.1016/j.hpb.2023.03.002

The role of hepatectomy for hepatocellular carcinoma (HCC) with multifocality or intrahepatic vascular involvement remains ill-defined. Our objective was to evaluate benefits of surgical resection for patients with these high-risk features.
The National Cancer Database was used to identify HCC patients with vascular involvement and/or multifocality (T2/T3, N-/M−) from 2011 to 2015. Propensity score matching (k-nearest neighbors, no replacement, 1:1) grouped patients by treatment: surgical resection versus non-surgical modalities. Groups were matched using patient, clinical, and liver-specific characteristics. Median overall survival (OS) was calculated using Kaplan–Meier, and adjusted analyses were performed using shared frailty models.
14,557 patients met inclusion criteria, including 1892 (9.4%) treated with surgical resection. Median cohort OS was 20.5 months. After adjustment, surgical resection was associated with survival advantage compared to non-surgical treatment (37.8 versus 15.7 months, log-rank P < .001; adjusted hazard ratio 0.49, 95% confidence interval, 0.45–0.54). Patients with minimal comorbidity, unifocal disease, and age <54 had highest probability of survival one year post-surgery.
Surgical resection is associated with a survival advantage in HCC with multifocality and/or intrahepatic vascular involvement. The presence of these features should not contraindicate consideration of hepatectomy in suitable surgical candidates.
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