Assessment of non-surgical versus surgical therapy for localized hepatocellular carcinoma

Sanjay Mohanty*, Ravi Rajaram, Karl Y Bilimoria, Riad Salem, Timothy M. Pawlik, David Jason Bentrem

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Localized hepatocellular carcinoma (HCC) in patients with adequate liver function is typically treated with resection. Non-surgical modalities including trans-arterial embolization have emerged as options for intermediate/advanced HCC. Hypothesizing that non-surgical techniques have expanded to localized disease, we examined treatment patterns, factors associated with surgical therapy, and the impact of modality on survival. Methods Non-cirrhotic, localized HCC patients were identified from the National Cancer Data Base (2003-2011). Trends were examined using average annual percent change (AAPC). Regression models were developed to determine factors associated with treatment and assess the association of modality with survival. Results Of 10,187 patients (median tumor size: 3.7 cm), 6,387 (62.7%) underwent surgery and 3,800 (37.3%) non-surgical therapy. Surgery declined from 61.6% to 44.5% (AAPC, -3.7%; 95%CI, -4.9% to -2.6%, P < 0.001). Non-surgical therapies increased from 17.2% to 39.2% (AAPC 11.4%; 95%CI, 8.8-14.1%, P < 0.001). White race, higher income, and treatment in an academic center (OR = 1.37, 95%CI 1.13-1.66) were associated with surgery. Patients selected for non-surgical therapy had worse adjusted 5-year survival (HR=2.05, 95%CI 1.85-2.26). Conclusions Non-surgical therapy has become as common as surgery in the treatment of non-cirrhotic, localized HCC. Randomized studies are needed to compare the effectiveness of treatments for this disease.

Original languageEnglish (US)
Pages (from-to)175-180
Number of pages6
JournalJournal of surgical oncology
Volume113
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Hepatocellular Carcinoma
Therapeutics
Survival
Neoplasms
Databases
Liver

Keywords

  • hepatocellular carcinoma
  • therapy
  • treatment trends

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{35db28b7ba9f421699e465bbe1e3cbcb,
title = "Assessment of non-surgical versus surgical therapy for localized hepatocellular carcinoma",
abstract = "Background Localized hepatocellular carcinoma (HCC) in patients with adequate liver function is typically treated with resection. Non-surgical modalities including trans-arterial embolization have emerged as options for intermediate/advanced HCC. Hypothesizing that non-surgical techniques have expanded to localized disease, we examined treatment patterns, factors associated with surgical therapy, and the impact of modality on survival. Methods Non-cirrhotic, localized HCC patients were identified from the National Cancer Data Base (2003-2011). Trends were examined using average annual percent change (AAPC). Regression models were developed to determine factors associated with treatment and assess the association of modality with survival. Results Of 10,187 patients (median tumor size: 3.7 cm), 6,387 (62.7{\%}) underwent surgery and 3,800 (37.3{\%}) non-surgical therapy. Surgery declined from 61.6{\%} to 44.5{\%} (AAPC, -3.7{\%}; 95{\%}CI, -4.9{\%} to -2.6{\%}, P < 0.001). Non-surgical therapies increased from 17.2{\%} to 39.2{\%} (AAPC 11.4{\%}; 95{\%}CI, 8.8-14.1{\%}, P < 0.001). White race, higher income, and treatment in an academic center (OR = 1.37, 95{\%}CI 1.13-1.66) were associated with surgery. Patients selected for non-surgical therapy had worse adjusted 5-year survival (HR=2.05, 95{\%}CI 1.85-2.26). Conclusions Non-surgical therapy has become as common as surgery in the treatment of non-cirrhotic, localized HCC. Randomized studies are needed to compare the effectiveness of treatments for this disease.",
keywords = "hepatocellular carcinoma, therapy, treatment trends",
author = "Sanjay Mohanty and Ravi Rajaram and Bilimoria, {Karl Y} and Riad Salem and Pawlik, {Timothy M.} and Bentrem, {David Jason}",
year = "2016",
month = "2",
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doi = "10.1002/jso.24113",
language = "English (US)",
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Assessment of non-surgical versus surgical therapy for localized hepatocellular carcinoma. / Mohanty, Sanjay; Rajaram, Ravi; Bilimoria, Karl Y; Salem, Riad; Pawlik, Timothy M.; Bentrem, David Jason.

In: Journal of surgical oncology, Vol. 113, No. 2, 01.02.2016, p. 175-180.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Assessment of non-surgical versus surgical therapy for localized hepatocellular carcinoma

AU - Mohanty, Sanjay

AU - Rajaram, Ravi

AU - Bilimoria, Karl Y

AU - Salem, Riad

AU - Pawlik, Timothy M.

AU - Bentrem, David Jason

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background Localized hepatocellular carcinoma (HCC) in patients with adequate liver function is typically treated with resection. Non-surgical modalities including trans-arterial embolization have emerged as options for intermediate/advanced HCC. Hypothesizing that non-surgical techniques have expanded to localized disease, we examined treatment patterns, factors associated with surgical therapy, and the impact of modality on survival. Methods Non-cirrhotic, localized HCC patients were identified from the National Cancer Data Base (2003-2011). Trends were examined using average annual percent change (AAPC). Regression models were developed to determine factors associated with treatment and assess the association of modality with survival. Results Of 10,187 patients (median tumor size: 3.7 cm), 6,387 (62.7%) underwent surgery and 3,800 (37.3%) non-surgical therapy. Surgery declined from 61.6% to 44.5% (AAPC, -3.7%; 95%CI, -4.9% to -2.6%, P < 0.001). Non-surgical therapies increased from 17.2% to 39.2% (AAPC 11.4%; 95%CI, 8.8-14.1%, P < 0.001). White race, higher income, and treatment in an academic center (OR = 1.37, 95%CI 1.13-1.66) were associated with surgery. Patients selected for non-surgical therapy had worse adjusted 5-year survival (HR=2.05, 95%CI 1.85-2.26). Conclusions Non-surgical therapy has become as common as surgery in the treatment of non-cirrhotic, localized HCC. Randomized studies are needed to compare the effectiveness of treatments for this disease.

AB - Background Localized hepatocellular carcinoma (HCC) in patients with adequate liver function is typically treated with resection. Non-surgical modalities including trans-arterial embolization have emerged as options for intermediate/advanced HCC. Hypothesizing that non-surgical techniques have expanded to localized disease, we examined treatment patterns, factors associated with surgical therapy, and the impact of modality on survival. Methods Non-cirrhotic, localized HCC patients were identified from the National Cancer Data Base (2003-2011). Trends were examined using average annual percent change (AAPC). Regression models were developed to determine factors associated with treatment and assess the association of modality with survival. Results Of 10,187 patients (median tumor size: 3.7 cm), 6,387 (62.7%) underwent surgery and 3,800 (37.3%) non-surgical therapy. Surgery declined from 61.6% to 44.5% (AAPC, -3.7%; 95%CI, -4.9% to -2.6%, P < 0.001). Non-surgical therapies increased from 17.2% to 39.2% (AAPC 11.4%; 95%CI, 8.8-14.1%, P < 0.001). White race, higher income, and treatment in an academic center (OR = 1.37, 95%CI 1.13-1.66) were associated with surgery. Patients selected for non-surgical therapy had worse adjusted 5-year survival (HR=2.05, 95%CI 1.85-2.26). Conclusions Non-surgical therapy has become as common as surgery in the treatment of non-cirrhotic, localized HCC. Randomized studies are needed to compare the effectiveness of treatments for this disease.

KW - hepatocellular carcinoma

KW - therapy

KW - treatment trends

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