The impact of liver resection on survival outcomes of hepatocellular carcinoma patients with extrahepatic metastases: A propensity score matching study

Abstract

BackgroundThe majority of hepatocellular carcinoma patients (HCCs) with extrahepatic metastases die of progressive intrahepatic tumor. There have been little data on the role of primary tumor resection (PTR) for HCCs with extrahepatic metastases but with resectable primary tumors.MethodsA retrospective study was conducted on HCCs with extrahepatic metastases with resectable primary tumors who either underwent or did not undergo PTR in the SEER registry between 2004 and 2013. The overall and cancer‐specific survivals (OS and CSS) were assessed by the log‐rank test and the Cox proportional hazard regression model. A propensity score matching was conducted to minimize biases. Validation was performed in another cohort from the Sun Yat‐sen Memorial Hospital (SYSMH).ResultsOf the 529 HCCs with extrahepatic metastases with resectable primary tumors included into this study, 230 patients underwent PTR and 299 did not. The percentages of patients who underwent PTR increased from 38.6% in 2004 to 70.3% in 2013. In the propensity score‐matched patients, PTR was associated with improved OS (HR 0.310, P < 0.001) and CSS (HR 0.326, P <0.001). These improvements in survivals remained significant after sensitivity analyses using multiple imputation. In the validation cohort from the SYSMH (n = 131), PTR was also correlated with improved OS (HR 0.508, P = 0.002) and CSS (HR 0.568, P = 0.017).ConclusionsThis study using propensity score matching and multiple imputation demonstrated that PTR had a favorable impact on the prognosis of HCCs with extrahepatic metastases with resectable primary tumors. Further prospective randomized trials are needed to confirm these findings.

Hepatic Resection Is Associated With Improved Long-Term Survival Compared to Radio-Frequency Ablation in Patients With Multifocal Hepatocellular Carcinoma

“…In our study which focused on patients with multifocal HCC, we also found HR led to a similar survival outcome as RFA in patients with tumors sized <3 cm; however, HR resulted in a considerable survival advantage over RFA among patients with HCC tumors sized 3-5 and >5 cm. In patients with tumors larger than 3 cm in size but not exceeding 5 cm, those who underwent HR had a superior outcome compared to those who underwent RFA in both the multivariate regression and subgroup analysis, consistent with previous research (13,14,22,28). Moreover, a novel finding of our study was that HR was a valuable treatment modality superior to RFA for multifocal HCC sized larger than 5 cm.…”

“…Hepatic failure is the most severe complication of HR; however, conservative treatment following HR can result in recovery. Studies have argued that HR could result in a long survival time even for HCC in BCLC intermediate-stage, with the presence of distant metastasis and portal vascular invasion, but multifocality was not mentioned (28,31,32). Until now, data for survival outcomes related to the treatment of multifocal HCC have been limited.…”

Impact of Extrahepatic Metastases on Overall Survival in Patients with Advanced Liver Dominant Hepatocellular Carcinoma: A Subanalysis of the SORAMIC Trial

“…In a retrospective analysis of 240 patients with HCC and extrahepatic metastases, Child-Pugh stage, smaller hepatic tumor size, absence of portal venous invasion, single metastatic organ involvement, and objective treatment response of the intrahepatic tumor were favorable prognostic factors [18]. A retrospective analysis from the SEER registry of 529 patients with HCC and extrahepatic metastases with resectable primary tumors even revealed that resection of the primary was associated with improved overall survival [33]. Patients with advanced HCC treated with sorafenib benefited from additional locoregional treatment with prolonged survival in a retrospective analysis of 312 cases [19].…”

A nomogram predicting the prognosis of young adult patients diagnosed with hepatocellular carcinoma: A population-based analysis

“…Consequently, these patients undoubtedly had a dismal prognosis. In contrast, Mao et al [30] demonstrated that primary tumor resection could bring survival benefit to selected HCC patients with resectable extrahepatic metastasis, which was similar to the results of Hu’s study [31]. In the future, the treatment of HCC patients with late cancer stage should be further explored, as a better treatment strategy is still needed.…”