Comparison of short- and long-term outcomes of patients with hepatocellular carcinoma undergoing surgical resection, local ablation, angiological treatment or palliation: Single center results over 35 years

Background Hepatocellular carcinoma (HCC) is one leading cause of cancer mortality often presenting at inoperable stage. The aim of this study was to examine and compare surgically resected, locally ablated, angiologically treated and palliatively treated HCC patients’ short- and long-term outcomes in a single center over 35 year period. Methods All HCC diagnosed in Oulu University Hospital between 1983-2018 were identified from hospital records (n=273). Patients underwent hepatic resection (n=49), local ablation (RF, laser ablation or PEI; n=25), angiological treatments (TACE, TAE and SIRT; n=48) or palliative treatment (chemotherapy, best supportive care; n=151). Primary outcomes of the study were postoperative complications within 30 days after the operation, and short- (30- and 90-day) and long-term (1, 3 and 5-year) survival. Results were adjusted with sex, age, comorbidities, cirrhosis, Child-Pugh index points, ASA status, year of operation and stage. Results Surgically resected patients were younger than patients in other groups. Recurrence and local recidives occurred more often in local ablation group and in angiological treatment group (p<0.001). Surgical resection rate was 17.9%. Overall complication rates in surgical resection, local ablation and angiological group were 71.5%, 32.0% and 58.3%, (p<0.001). Major complications in respective groups occurred in 28.6%, 8.0% and 27.1%. Overall survival rates in surgical resection group were at 30 and 90 days, 1-, 3 and 5-years 95.9%, 95.9%, 85.1%, 59.0% and 51.2%. In local ablation group, respective overall survival rates were 100.0%, 100.0%, 86.1%, 43.1% and 18.8%, and in angiological group 95.8%, 93.6%, 56.1%, 26.3% and 6.6%. In cox regression model adjusted for confounding factors, local ablation and angiological treatment were significant risk factors for mortality. Prognosis was poor in palliatively treated patients. Conclusions Based on our study on Northern Finland population, the surgical resection of HCC seems to be the most effective treatment considering long-term survival and tumor recurrence after adjustment for confounding factors.