Role of Operative Therapy in Non-cirrhotic Patients with Metastatic Hepatocellular Carcinoma

Introduction

We investigated the role of operative therapy in non-cirrhotic patients who developed metastatic hepatocellular carcinoma (HCC).

Methods

This retrospective cohort study included consecutive non-cirrhotic patients with metastatic HCC after a prior hepatectomy treated between 1990 and 2009. Patients were stratified by operative therapy (resection, ablation, transcatheter therapy). Kaplan?CMeier analyses with log-rank comparisons tested effects of operative therapy on overall survival (OS) and progression-free survival (PFS).

Results

Of 195 non-cirrhotic patients treated for HCC during the study period, 98 median age 65, interquartile range (IQR) 53?C71; 55?% male] subsequently developed metastatic HCC (55 intrahepatic only). Median time to development of metastases after the index operation was 10?months (IQR 5?C20?months); median number of metastases was 3 (IQR 2?C7). Half of these patients (n?=?50) underwent operative treatment of metastases; 20 (40?%) underwent metastasectomy, 18 (36?%) ablation, and 12 (24?%) transcatheter therapy. Operative therapy was associated with improved OS (p?p????0.006). Nine patients (seven resection, two ablation) are disease free at a median of 50?months (IQR 24?C80?months) posttreatment.

Conclusions

Resection and ablation are associated with an improved PFS and long-term OS and should be considered in select patients with metastatic HCC.