Trends in local therapy for hepatocellular carcinoma and survival outcomes in the US population

Background: Hepatocellular cancer (HCC) frequently presents with limitations to resection. We investigated survival outcomes after various local HCC therapies in US patients. Data sources: Relationships between local HCC therapy modality and overall survival (OS) were analyzed from the Surveillance, Epidemiology and End Results (SEER) 1973-2003 database. Of 46,065 patients with primary hepatobiliary malignancy, 5,317 individuals with HCC had sufficient surgical data. The median age was 65 (range 0-105), and 73% of patients were male. The median tumor size was 6 cm (.2-30). There were single lesions (52%), multiple lesions (28%), and extrahepatic disease (20%). Mortality at 30 days was 8.4% (resection), 3.3% (transplantation), 3.2% (ablation), or 31% (no local therapy, P <.0001). Actuarial 5-year survival was 67% after transplantation, 35% after resection, 20% after ablation, and 3% for no or incomplete local therapy (P <.0001). Multivariate prognosticators were surgical modality, disease extent, grade (all at P <.0001), tumor size (P = .01), vascular invasion (P = .02), and age (P = .045). Compared to resection, risk ratios were .56 (transplantation) and 1.53 (ablation). Conclusions: Long-term HCC survival can be observed after all 3 treatment approaches but is best after transplantation and resection, although likely biased through confounding patient selection variables. Preferred HCC treatment should be individualized based on morbidity and long-term OS prospects.