Long-Term Survival Outcomes of Liver Transplantation, Liver Resection, Ablative Therapy Among Patients with Early Solitary Primary Hepatocellular Carcinoma: A Population-Based Longitudinal Study

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: While treatment options for early solitary primary hepatocellular carcinoma (HCC) include radiofrequency ablation (RFA), liver resection (LR), and liver transplantation (LT), controversy exists on the optimal treatment choice. Due to ethical reasons, a randomized trial comparing these options has not been conducted. Furthermore, previous studies have primarily evaluated the treatment effect among smaller cohorts and are often limited to individual institutions and conducted over shorter period. Hence, using a population-based database that span several decades, we aimed to evaluate the long-term survival outcomes in patients with solitary early-stage primary HCC carcinoma who had either LT, LR or RFA Methods: This was a longitudinal cohort study using data obtained from the Surveillance, Epidemiology, and End Results registry database which covers about 30% of USA’s population. In this study, patients who were ≥18 years, with solitary primary HCC ≤ 3cm, without vascular invasion, between 2004 and 2021 were included. Excluded were those with unknown follow-up status or those with survival time < 1 month. The outcome of interest was cancer-related survival, which was assessed with the Kaplan-Meier method. A multivariate analysis was conducted using the Cox proportional hazard model to identify factors associated with survival. The significance level was assessed at p <0.05. Results: 5,115 patients with early solitary primary HCC met the inclusion criteria, out of which 1,156 (22.6%) underwent LT; 1,071(20.9%) underwent SR; and 2,888 (56.5%) underwent RFA. The 1 yr survival rate in the LT group was 97% compared to 95% in the SR and RFA cohort (Fig 1). In the adjusted model, patients who had RFA had a lower long-term survival when compared to the LT cohort. The RFA cohort had a 5-fold risk of cancer-related death (HR: 5.37 [95% CI 4.37-6.60]; p <0.001), while the risk of cancer-related death was 3-fold higher in the SR group (HR: 3.30 [95% CI 2.62-4.15]; p <0.001) when compared to the LR group. Furthermore, patients with elevated AFP had a 32% increased risk of cancer-related death [HR:1.32 (95%CI: 1.18,1.49)]. Also, for every cm increase in the size of the tumor, there was a 3% increased risk of death [HR:1.03 (95%CI:1.02,1.04)]. The risk of death was 43% lower among Asians/Pacific Islanders [HR: 0.57 (95%CI:0.59,0.67)] compared to Caucasians. Conclusions: Although LT confers improved long-term survival since LT reduces the risk of recurrence. The comparable one-year survival rate with SR & RFA suggests that SR & RFA could be used as a bridging treatment option. [Formula presented] CITATION INFORMATION: Oluborode B., Malinzak L., Nagai S., Abouljoud M., Yoshida A. Long-Term Survival Outcomes of Liver Transplantation, Liver Resection, Ablative Therapy Among Patients with Early Solitary Primary Hepatocellular Carcinoma: A Population-Based Longitudinal Study AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: B. Oluborode: None.

Volume

25

Issue

8

First Page

S706

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