Outcomes of Patients with Scirrhous Hepatocellular Carcinoma: Insights from the National Cancer Database

Autor: Timothy M. Pawlik, J. Madison Hyer, Eliza W. Beal, Kota Sahara, Anghela Z. Paredes, Ayesha Farooq, Diamantis I. Tsilimigras, Lu Wu, Katiuscha Merath, Rittal Mehta
Rok vydání: 2019
Předmět:
Zdroj: Journal of Gastrointestinal Surgery. 24:1049-1060
ISSN: 1873-4626
1091-255X
DOI: 10.1007/s11605-019-04282-1
Popis: Scirrhous hepatocellular carcinoma (HCC) is a rare primary liver tumor characterized by extensive fibrosis and production of parathyroid hormone–related peptide. There have been conflicting reports on patient survival in scirrhous versus non-scirrhous HCC. The objective of the present study was to define the clinical features, practice patterns, and long-term outcomes of patients with scirrhous HCC versus non-scirrhous HCC in a propensity score–matched cohort. A propensity score–matched cohort was created using data from the National Cancer Database for 2004 to 2015. A multivariable Cox proportional hazards regression analysis was performed to assess the effect of the scirrhous HCC variant on overall survival. Among the 70,426 patients with a diagnosis of HCC who met the inclusion criteria, 99.8% had non-scirrhous HCC (n = 70,290) whereas a small subset had scirrhous HCC (n = 136, 0.19%). While 20,330 (28.9%) patients underwent liver-directed therapy (resection, ablation, and transplantation), the majority did not (n = 50,096, 71.1%). After propensity matching, there were no difference in 1-, 3-, or 5-year overall survival among patients with scirrhous versus non-scirrhous HCC (1-year overall survival (OS), 53.7% versus 51.0%; 3-year OS, 34.6% versus 28.7%; and 5-year OS, 18.0% versus 21.0%, respectively; p = 0.52). While the scirrhous HCC variant was not associated with survival (hazard ratio [HR] 0.93, 95% CI 0.74–1.16), non-receipt of liver-directed therapy (HR 0.24, 95% CI 0.18–0.32), advanced AJCC stage (III/IV) (HR 2.14, 95% CI 1.55–2.95), and non-academic facilities (HR 0.60, 95% CI 0.49–0.73) remained associated with worse survival. Patients with the scirrhous variant had a comparable overall survival compared with individuals who had non-scirrhous HCC. Failure to receive liver-directed therapy, advanced AJCC stage (III/IV), and treatment at a non-academic facility was strongly associated with a worse long-term prognosis.
Databáze: OpenAIRE
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