Long-term Survival Following Surgery versus Ablation for Early Liver Cancer in a Large, Nationally Representative Cohort.
Academic Article
Overview
abstract
OBJECTIVE: To compare survival outcomes (all-cause, cancer-specific, and disease-free) for small HCC, less than or equal to 5 cm, following ablation (AB) and surgical resection (SR) after adjusting for key confounders. Secondarily, to understand differential survival outcomes of liver transplant (TR) compared to SR and AB. METHODS: Using SEER-Medicare, HCC less than 5 cm that were treated with AB, SR or TR in 2009-2016 (N=1,215) were identified using Healthcare Common Procedure Coding System (HCPCS) codes through Medicare claims. TR group was subdivided into two groups TR with prior treatment (TRW) and TR without prior treatment (TRWO). All-cause survival, cancer-specific survival and disease-free survival were analyzed using Kaplan-Meier curves and compared between groups using log-rank tests and Cox regression analyses. Propensity score matched comparison of AB and SR groups was performed, with groups matched on demographics, social determinants of health, medical comorbidities and liver disease severity prognostic indicators. RESULTS: Median study follow-up time was 2.71 years (IQR 1.25-3.83). Unadjusted 1-, 3-, and 5-year cancer-specific survivals were 85.9%, 67.6% and 56.3% for AB group, 91.7%, 82.6%, and 81.7% for SR group, 93.5%, 88.7%, and 79.4% for TRWO group, and 96.4%, 93.2%, and 93.2% for TRW group (p-values <0.0001). With SR as the reference group, the propensity matched hazard ratios for AB were 2.04 (95% CI: 1.51-2.77) for all-cause mortality, 2.44 (95% CI: 1.56-3.80) for cancer-specific mortality and 2.12 (95% CI: 1.61-2.78) for disease recurrence. DISCUSSION: SR is superior to AB for small HCC in a large, nationally representative, modern cohort, while in secondary analysis TR was superior to both.
