Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison |
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| Authors: | Simone Famularo Matteo Donadon Federica Cipriani Davide P. Bernasconi Giuliano LaBarba Tommaso Dominioni Maurizio Iaria Sarah Molfino Simone Conci Cecilia Ferrari Marco Garatti Antonella Delvecchio Albert Troci Stefan Patauner Silvia Frassani Maurizio Cosimelli Giacomo Zanus Felice Giuliante Valerio De Peppo |
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| Affiliation: | 1. School of Medicine and Surgery, University of Milano-Bicocca, Department of Surgery, San Gerardo Hospital, Monza, Italy;2. Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, Milan, Italy;3. Hepatobiliary Surgery Division, Ospedale San Raffaele, Milano, Italy;4. Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy;5. General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy;6. Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy;7. Department of Surgery, University of Parma, Parma, Italy;8. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy;9. Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy;10. HPB Surgical Unit, San Paolo Hospital, Savona, Italy;11. Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy;12. Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy;13. Department of Surgery, L. Sacco Hospital, Milan, Italy;14. Department of Surgery, Bolzano Central Hospital, Bolzano, Italy;15. Department of Surgery, Monza Policlinic, Monza, Italy;16. Division of Hepatobiliarypancreatic Surgery, IRCCS - Regina Elena National Cancer Institute, Rome, Italy;17. Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit - Treviso Hospital, Italy;18. Hepatobiliary Surgery Unit, Fondazione “Policlinico Universitario A. Gemelli,” Catholic University of the Sacred Heart, Rome, Italy;19. AOU Sant''Orsola Malpighi, IRCCS, Bologna, Italy |
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| Abstract: | BackgroundManagement of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC.MethodsThis is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups.Results1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p<0.001).ConclusionCurative approaches may guarantee long-term survival in case of recurrence. |
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