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26.06.2019 | Original Article

Outcomes of Patients with Scirrhous Hepatocellular Carcinoma: Insights from the National Cancer Database

Zeitschrift:
Journal of Gastrointestinal Surgery
Autoren:
Ayesha Farooq, Katiuscha Merath, Anghela Z. Paredes, Lu Wu, Diamantis I. Tsilimigras, J. Madison Hyer, Kota Sahara, Rittal Mehta, Eliza W. Beal, Timothy M. Pawlik
Wichtige Hinweise
Drs. Ayesha Farooq and Katiuscha Merath made equal contributions to this work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Abstract

Introduction

Scirrhous hepatocellular carcinoma (HCC) is a rare primary liver tumor characterized by extensive fibrosis and production of parathyroid hormone–related peptide. There have been conflicting reports on patient survival in scirrhous versus non-scirrhous HCC. The objective of the present study was to define the clinical features, practice patterns, and long-term outcomes of patients with scirrhous HCC versus non-scirrhous HCC in a propensity score–matched cohort.

Methods

A propensity score–matched cohort was created using data from the National Cancer Database for 2004 to 2015. A multivariable Cox proportional hazards regression analysis was performed to assess the effect of the scirrhous HCC variant on overall survival.

Results

Among the 70,426 patients with a diagnosis of HCC who met the inclusion criteria, 99.8% had non-scirrhous HCC (n = 70,290) whereas a small subset had scirrhous HCC (n = 136, 0.19%). While 20,330 (28.9%) patients underwent liver-directed therapy (resection, ablation, and transplantation), the majority did not (n = 50,096, 71.1%). After propensity matching, there were no difference in 1-, 3-, or 5-year overall survival among patients with scirrhous versus non-scirrhous HCC (1-year overall survival (OS), 53.7% versus 51.0%; 3-year OS, 34.6% versus 28.7%; and 5-year OS, 18.0% versus 21.0%, respectively; p = 0.52). While the scirrhous HCC variant was not associated with survival (hazard ratio [HR] 0.93, 95% CI 0.74–1.16), non-receipt of liver-directed therapy (HR 0.24, 95% CI 0.18–0.32), advanced AJCC stage (III/IV) (HR 2.14, 95% CI 1.55–2.95), and non-academic facilities (HR 0.60, 95% CI 0.49–0.73) remained associated with worse survival.

Conclusion

Patients with the scirrhous variant had a comparable overall survival compared with individuals who had non-scirrhous HCC. Failure to receive liver-directed therapy, advanced AJCC stage (III/IV), and treatment at a non-academic facility was strongly associated with a worse long-term prognosis.

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