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The role of definitive local treatment in metastatic hepatocellular carcinoma patients: A SEER-based study.

ABSTRACT: In the present study, we aimed to investigate the survival benefit from definitive local treatment (LT) for hepatocellular carcinoma patients with distant metastasis (mHCC).We retrospectively analyzed mHCC patients from Surveillance, Epidemiology, and End Results (SEER) Database. The patients' clinical and pathological characteristics were analyzed. Overall survival (OS) was calculated by Kaplan-Meier method. Independent risk factors associated with disease special mortality (DSM) were identified by multivariable regression analysis.A total of 7187 mHCC patients from SEER database were identified. A total of 258 (3.6%) patients had received surgery treatment (ST), 64 (0.9%) patients underwent radiotherapy (RT), and 6865 (95.5%) patients were identified to no surgery or radiation therapy group (NSR). Compared with the patients in NSR group, patients who received ST (hazard ratio [HR]: 0.26, 95% confidence interval [CI] 0.22-0.31, P?50 years, female, and T3 or higher stage were associated with increased DSM.The present study demonstrated the survival benefit of definitive LT in mHCC patients. However, a large randomized clinical trial to validate the role of LT in mHCC is necessary in the future.

SUBMITTER: Su M

PROVIDER: S-EPMC5882428 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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The role of definitive local treatment in metastatic hepatocellular carcinoma patients: A SEER-based study.

Su Mingxue M Zhao Yuanyuan Y Liu Jianjun J

Medicine 20180301 10

In the present study, we aimed to investigate the survival benefit from definitive local treatment (LT) for hepatocellular carcinoma patients with distant metastasis (mHCC).We retrospectively analyzed mHCC patients from Surveillance, Epidemiology, and End Results (SEER) Database. The patients' clinical and pathological characteristics were analyzed. Overall survival (OS) was calculated by Kaplan-Meier method. Independent risk factors associated with disease special mortality (DSM) were identifie ...[more]

PMID: 29517658

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Project description:It is controversial regarding the treatment allocation for patients with stage I hepatocellular carcinoma (SI-HCC). The aim of the present study was to compare the long-term survival in SI-HCC patients undergoing liver transplantation (LT), liver resection (LR), local tumor destruction (LTD), or none. SI-HCC patients diagnosed between 2004 and 2015 were extracted from the SEER 18 registry database. Multivariable Cox models and propensity score matching (PSM) method were used to explore the association between surgical methods and long-term prognosis. A total of 5165 patients with stage I (AJCC, 6th or 7th) HCC were included in the study. Only 36.9% of patients diagnosed with HCC in stage I received surgical therapy. The incidence of LT was decreased over time (P?<?.001). In the multivariable-adjusted cohort (n?=?5165), after adjusting potential confounding factors, a clear prognostic advantage of LT was observed in OS (P?<?.0001) compared with patients after LR. Patients undergoing LTD had a worse OS in comparison with patients who underwent LR (P?<?.0001). Patients who received no surgical treatment had the worst OS (P?<?.0001) among 4 treatment groups. In stratified analyses, the salutary effects of LT vs LR on OS were consistent across all subgroups except for a similar result in the noncirrhotic subgroup (P?=?.4414). The inferior survival effects of LTD vs LR on OS were consistent across all subgroups, and even in the subgroup with tumor size?<?3?cm (P?=?.0342). In the PSM cohort, patients in LT group showed a better OS (P?<?.001) than patients in LR group (P?<?.0001) and patients undergoing LTD had a worse OS compared with patients who underwent LR (P?=?.00059). In conclusion, LT offered a survival advantage compared with LR among patients with Stage I HCC. LT is the best surgical treatment for stage I HCC in patients with advanced fibrosis, whereas LR provides comparable long-term outcomes to LT in patients without advanced fibrosis and should be considered as the first-line surgical option. LTD can be used as an alternative method when LR and LT are unavailable.

Project description:BackgroundWe aimed to explore the role of local ablative treatment (LAT) in metastatic esophageal squamous cell cancer (ESCC) patients who received chemotherapy and identify patients who will most likely benefit.MethodsWe analyzed data of metastatic ESCC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. The chi-square test was used to evaluate the unadjusted clinicopathological categorical variables between the two groups. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors of overall survival. Propensity score matching (PSM) was used to adjust the differences between the two groups.ResultsOverall, 720 metastatic ESCC patients treated with chemotherapy were analyzed in this study; 63.2% of patients (n = 455) received LAT, including radiotherapy (n = 444), primary site surgery (n = 12), or lymph node dissection (n = 27). Gender (HR = 1.220, 95% CI: 1.024-1.453, p = 0.026), bone metastases (HR = 1.559, 95% CI: 1.292-1.882, p < 0.001), and liver metastases (HR = 1.457, 95% CI: 1.237-1.716, p < 0.001) were independent prognostic factors in the entire population. However, LAT was not an independent prognostic factor. Further subgroup analyses showed that LAT improved OS from 8.0 months to 10.0 months in patients with metastases other than bone/liver (HR = 0.759, 95% CI: 0.600-0.961, p = 0.022). LAT was not a prognostic factor in patients with bone/liver metastases (HR = 0.995, 95% CI: 0.799-1.239, p = 0.961). After PSM, the median OS was 8.0 months (95% CI: 7.2-8.8 months) and patients who received LAT had a better OS than patients without LAT (HR = 0.796, 95% CI: 0.653-0.968, p = 0.023). Patients with metastases other than bone/liver could benefit from LAT compared with those with bone/liver metastases.ConclusionsOur study indicated that metastatic ESCC patients with metastases other than bone/liver could derive additional benefit from LAT with systemic chemotherapy.

Project description:Background: Primary liver cancer is a common malignant tumor primarily represented by hepatocellular carcinoma (HCC). The number of elderly patients with early HCC is increasing, and older age is related to a worse prognosis. However, an accurate predictive model for the prognosis of these patients is still lacking. Methods: Data of eligible elderly patients with early HCC in Surveillance, Epidemiology, and End Results database from 2010 to 2016 were downloaded. Patients from 2010 to 2015 were randomly assigned to the training cohort (n = 1093) and validation cohort (n = 461). Patients' data in 2016 (n = 431) was used for external validation. Independent prognostic factors were obtained using univariate and multivariate analyses. Based on these factors, a cancer-specific survival (CSS) nomogram was constructed. The predictive performance and clinical practicability of our nomogram were validated. According to the risk scores of our nomogram, patients were divided into low-, intermediate-, and high-risk groups. A survival analysis was performed using Kaplan-Meier curves and log-rank tests. Results: Age, race, T stage, histological grade, surgery, radiotherapy, and chemotherapy were independent predictors for CSS and thus were included in our nomogram. In the training cohort and validation cohort, the concordance indices (C-indices) of our nomogram were 0.739 (95% CI: 0.714-0.764) and 0.756 (95% CI: 0.719-0.793), respectively. The 1-, 3-, and 5-year areas under receiver operating characteristic curves (AUCs) showed similar results. Calibration curves revealed high consistency between observations and predictions. In external validation cohort, C-index (0.802, 95%CI: 0.778-0.826) and calibration curves also revealed high consistency between observations and predictions. Compared with the TNM stage, nomogram-related decision curve analysis (DCA) curves indicated better clinical practicability. Kaplan-Meier curves revealed that CSS significantly differed among the three different risk groups. In addition, an online prediction tool for CSS was developed. Conclusions: A web-based prediction model for CSS of elderly patients with early HCC was constructed and validated, and it may be helpful for the prognostic evaluation, therapeutic strategy selection, and follow-up management of these patients.

Dataset Information

The role of definitive local treatment in metastatic hepatocellular carcinoma patients: A SEER-based study.

Publications

The role of definitive local treatment in metastatic hepatocellular carcinoma patients: A SEER-based study.

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