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A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC East-West study group.
- Source :
-
Annals of surgery [Ann Surg] 2013 May; Vol. 257 (5), pp. 929-37. - Publication Year :
- 2013
-
Abstract
- Objective: The aim of this study was to investigate in a retrospective setting the patients' profile and results of those undergoing surgery for hepatocellular carcinoma (HCC) in high-volume surgical centers throughout the world.<br />Background: Whether surgery for HCC is a suitable approach and for which subset of patients is still controversial. The EASL/AASLD (European Association for the Study of Liver Disease/American Association for the Study of Liver Disease) guidelines, based on the Barcelona Clinic Liver Cancer (BCLC) classification, leave little room for hepatic resection; inversely, other reports promote its wider application.<br />Methods: On the basis of the network "Hepatocellular Carcinoma: Eastern & Western Experiences," data for 2046 consecutive patients resected for HCC in 10 centers were collected. According to the BCLC classification, 1012 (50%) were BCLC 0-A, 737 (36%) BCLC B, and 297 (14%) BCLC C. Analysis of overall survival and disease-free survival and multivariate analysis of prognostic factors were performed.<br />Findings: The 90-day mortality rate was 2.7%. Overall morbidity was 42%. After a median follow-up of 25 months (range, 1-209 months), the 1-, 3-, and 5-year overall survival rates were 95%, 80%, and 61% for BCLC 0-A; 88%, 71%, and 57% for BCLC B; and 76%, 49%, and 38% for BCLC C (P = 0.000). The 1-, 3-, and 5-year disease-free survival rates were as follows: 77%, 41%, and 21% for BCLC 0-A; 63%, 38%, and 27% for BCLC B; and 46%, 28%, and 18% for BCLC C (P = 0.000). The multivariate analysis identified bilirubin, cirrhosis, esophageal varices, tumor size, and macrovascular invasion to be statistical and independent prognostic factors for overall survival.<br />Conclusions: This large multicentric survey shows that surgery is in current practice widely applied among patients with multinodular, large, and macrovascular invasive HCC, providing acceptable short- and long-term results and justifying an update of the EASL/AASLD therapeutic guidelines in this sense.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular mortality
Carcinoma, Hepatocellular pathology
Child
Female
Follow-Up Studies
Hepatectomy mortality
Humans
Liver Neoplasms mortality
Liver Neoplasms pathology
Male
Middle Aged
Multivariate Analysis
Neoplasm Staging
Postoperative Complications epidemiology
Practice Guidelines as Topic
Preoperative Care methods
Retrospective Studies
Survival Analysis
Treatment Outcome
Young Adult
Carcinoma, Hepatocellular surgery
Guideline Adherence statistics & numerical data
Hepatectomy statistics & numerical data
Liver Neoplasms surgery
Practice Patterns, Physicians' statistics & numerical data
Tertiary Care Centers statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1140
- Volume :
- 257
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Annals of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 23426336
- Full Text :
- https://doi.org/10.1097/SLA.0b013e31828329b8