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The Trends and Efficacy of Surgery in the Treatment of Hepatocellular Carcinoma


 Background

Surgery for the treatment of hepatocellular carcinoma (HCC) is limited. Recently, the possibility was advanced that surgical approach could be applied in HCC patients more widely. To address this issue, the trends in the use of surgery (including liver resection and ablation et, al) and liver resection for the treatment of HCC with time was analyzed. Additionally, whether patients gain a better survival benefit from surgery and liver resection than other treatments was evaluated.
Methods

Data from SEER registries was used to analyze the trends in the use surgery and liver resection for HCC and the survival benefits of these procedures. The study included patients between the ages of 35 and 84 years diagnosed as HCC between 1998 and 2015 (n = 80499). Propensity score matching (PSM) analysis was used to reduce selection bias.
Results

From 1998 to 2015, the rate of surgery for HCC increased in all patients (P = 0.016) and in the localized group (P < 0.001), but decrease in the regional and distant groups (P < 0.001). Liver resection rate in the localized, regional, distant, and unknown/unstaged groups declined (P < 0.001, P = 0.004, P = 0.014, and P = 0.007, respectively). Surgery and liver resection rates in the localized group and its subgroups of localized group were reduced (all P < 0.05). The median overall survival (mOS) of patients undergoing surgery was longer than patients with non-surgery. Similar survival results were obtained in the analysis of the subgroups. The liver resection group had the longest mOS in all patients and in the localized (and it’s subgroups) and regional groups.
Conclusion

Although surgery rate in HCC patients increased slightly with time, liver resection rate in the localized group decreased. Surgery might be used more widely in the treatment of patients with hepatocellular carcinoma.