Abstract | OBJECTIVE: BACKGROUND: Statistical cure occurs when the mortality of a specific population returns to values of that of general population. Resection and transplantation are considered potentially curative therapies for HCC, but their effect on the residual entire life-expectancy has never been investigated. METHODS: Data from 3286 HCC patients treated with LT (n = 1218) or HR (n = 2068) were used to estimate statistical cure. Disease-free survival (DFS) was the primary survival measure to estimate cure fractions through a nonmixture model. Overall survival (OS) was a secondary measure. In both, patients were matched with general population by age, sex, year, and race/ethnicity. Cure variations after LT were also adjusted for different waiting-list drop-outs. RESULTS: Considering DFS, the cure fraction after LT was 74.1% and after HR was 24.1% (effect size >0.8). LT outperformed HR within all transplant criteria considered (effect size >0.8), especially for multiple tumors (>0.9) and even in presence of a drop-out up to 20% (>0.5). Considering OS, the cure fraction after LT marginally increased to 75.8%, and after that HR increased to 40.5%. The effect size of LT over HR in terms of cure decreased for oligonodular tumors (<0.5), became small for drop-out up to ∼20% (<0.2), and negligible for single tumors <5 cm (∼0.1). CONCLUSION: As other malignancies, statistical cure can occur for HCC, primarily with LT and secondarily with HR, depending on waiting-list capabilities and efficacy of tumor recurrence therapies after resection.
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Authors | Antonio Daniele Pinna, Tian Yang, Vincenzo Mazzaferro, Luciano De Carlis, Jian Zhou, Sasan Roayaie, Feng Shen, Carlo Sposito, Matteo Cescon, Stefano Di Sandro, He Yi-Feng, Philip Johnson, Alessandro Cucchetti |
Journal | Annals of surgery
(Ann Surg)
Vol. 268
Issue 5
Pg. 868-875
(11 2018)
ISSN: 1528-1140 [Electronic] United States |
PMID | 30080736
(Publication Type: Journal Article, Multicenter Study)
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Topics |
- Aged
- Carcinoma, Hepatocellular
(surgery)
- China
- Female
- Hepatectomy
- Humans
- Liver Neoplasms
(surgery)
- Liver Transplantation
- Male
- Middle Aged
- Reoperation
- Treatment Outcome
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