ORIGINAL ARTICLE   

Minerva Surgery 2021 June;76(3):252-63

DOI: 10.23736/S2724-5691.21.08426-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Treatment trends and outcomes of hepatocellular carcinoma in a single center for 35 years

Valtteri KAIRALUOMA ¹ ✉, Mira KARJALAINEN ¹, Vesa-Matti POHJANEN ¹, Juha SAARNIO ², Jarmo NIEMELÄ ², Heikki HUHTA ¹, Olli HELMINEN ^{1, 3}

¹ Unit of Cancer and Translational Medicine Research, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland; ² Department of Surgery, Oulu University Hospital, Oulu, Finland; ³ Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer mortality. The aim of this study was to examine the trends of HCC treatment and the outcomes in a single tertiary center for 35 years.
METHODS: Two hundred seventy-three consecutive HCC patients between 1983-2018 were identified from Oulu University Hospital records. 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: Of the 273 patients, 49 underwent surgical resection, 25 local ablation, 48 angiological treatment and 151 had palliative treatment. The rate of surgery declined over time, while other invasive treatments increased. Major complications occurred in 14 (28.6%) patients after surgical resection, in 2 (8.0%) patients after local ablation and in 13 (27.1%) patients after angiological treatment (P=0.022). Recurrence and local recidives were observed especially in local ablation group and in angiological treatment group (P<0.001). 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, mortality hazard was lowest after surgical resection. Prognosis was poor in palliative group.
CONCLUSIONS: Based on this Northern Finland population, the surgical resection of HCC has acceptable complication rate compared to other treatments; and yields the best long-term survival. Overall prognosis of HCC remains poor.

KEY WORDS: Carcinoma, hepatocellular; Surgical procedures, operative; Ablation techniques