. 2021 Apr 23;10(5):407-418.

doi: 10.1159/000515554. eCollection 2021 Sep.

Comparison of Surgical Resection and Systemic Treatment for Hepatocellular Carcinoma with Vascular Invasion: National Cancer Database Analysis

Rajalakshmi Govalan¹, Marie Lauzon^{2

3}, Michael Luu^{2

3}, Joseph C Ahn⁴, Kambiz Kosari^{2

5

6}, Tsuyoshi Todo^{2

5

6}, Irene K Kim^{5

6}, Mazen Noureddin^{1

5

7}, Alexander Kuo^{1

5

7}, Ayoub S Walid^{1

5

7}, Vinay Sundaram^{1

5

7}, Shelly C Lu^{1

2}, Lewis R Roberts⁴, Amit G Singal^{8

9}, Julie K Heimbach^{10

11}, Vatche G Agopian¹², Nicholas Nissen^{2

5

6}, Ju Dong Yang^{1

2

5

7}

Affiliations

¹ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
² Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
³ Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁴ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁶ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁷ Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁸ Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA.
⁹ Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.
¹⁰ Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Liver Transplant Program, Mayo Clinic, Rochester, Minnesota, USA.
¹² Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

PMID: 34721504
PMCID: PMC8527916
DOI: 10.1159/000515554

Comparison of Surgical Resection and Systemic Treatment for Hepatocellular Carcinoma with Vascular Invasion: National Cancer Database Analysis

Rajalakshmi Govalan et al. Liver Cancer. 2021.

. 2021 Apr 23;10(5):407-418.

doi: 10.1159/000515554. eCollection 2021 Sep.

Authors

Affiliations

¹ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
² Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
³ Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁴ Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁶ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁷ Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁸ Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA.
⁹ Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA.
¹⁰ Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Liver Transplant Program, Mayo Clinic, Rochester, Minnesota, USA.
¹² Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

PMID: 34721504
PMCID: PMC8527916
DOI: 10.1159/000515554

Abstract

Introduction: Small studies from outside of the USA suggest excellent outcomes after surgical resection for hepatocellular carcinoma (HCC) with vascular invasion. The study aims to (1) compare overall survival after surgical resection and systemic therapy among patients with HCC and vascular invasion and (2) determine factors associated with receipt of surgical resection in a US population.

Methods: HCC patients with AJCC clinical TNM stage 7th T3BN0M0 diagnosed between 2010 and 2017 from the National Cancer Database were analyzed. Cox and logistic regression analyses identified factors associated with overall survival and receipt of surgical resection.

Results: Of 11,259 patients with T3BN0M0 HCC, 325 (2.9%) and 4,268 (37.9%) received surgical resection and systemic therapy, respectively. In multivariable analysis, surgical resection was associated with improved survival compared to systemic therapy (adjusted hazard ratio: 0.496, 95% confidence interval: 0.426-0.578) with a median survival of 21.4 and 8.1 months, respectively. Superiority of surgical resection was observed in noncirrhotic and cirrhotic subgroups and propensity score matching and inverse probability of treatment weighting adjusted analysis. Asians were more likely to receive surgical resection, whereas Charlson comorbidity ≥3, elevated alpha-fetoprotein, smaller tumor size, care in a community cancer program, and the South or West region were associated with a lower likelihood of surgical resection.

Conclusion: HCC patients with vascular invasion may benefit from surgical resection compared to systemic therapies. Demographic and clinical features of HCC patients and region and type of treating facility were associated with surgical resection versus systemic treatment.

Keywords: Hepatocellular carcinoma; Prognosis; Surgical resection; Vascular invasion.

PubMed Disclaimer

Conflict of interest statement

Dr. Yang provides a consulting service for Exact Sciences, Eisai and Gilead. Dr. Singal has been on advisory boards and served as a consultant for Genentech, Bayer, Eisai, BMS, Exelixis, AstraZeneca, and TARGET RWE. Dr. Roberts is an editorial board member of Liver Cancer. The other authors have no potential conflict of interest.

Figures

**Fig. 1**
Kaplan-Meier survival analysis of patients with surgical resection vs. systemic therapy for their HCC with vascular invasion. a Before propensity score matching. b After propensity score matching. HCC, hepatocellular carcinoma.

**Fig. 2**
Survival estimate for HCC patients with vascular invasion who underwent surgical resection by surgical margin status. HCC, hepatocellular carcinoma.

See this image and copyright information in PMC

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Comparison of Surgical Resection and Systemic Treatment for Hepatocellular Carcinoma with Vascular Invasion: National Cancer Database Analysis

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Comparison of Surgical Resection and Systemic Treatment for Hepatocellular Carcinoma with Vascular Invasion: National Cancer Database Analysis

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