The trends and efficacy of operation in the treatment of hepatocellular carcinoma

BACKGROUND: Recently, the possibility was advanced that operation (including surgery, transplantation, and ablation, etc.) could be applied in hepatocellular carcinoma (HCC) patients more widely. The trend and efficacy of operation and surgery for the treatment of HCC with time was analyzed. METHODS: Data from Surveillance, Epidemiology, and End Results Program (SEER) registries were used to analyze the trends in the use operation and surgery for HCC and the survival benefits of these procedures. The study included patients between the ages of 35 and 84 years diagnosed as HCC between 2004 and 2015 (n=64,019). Propensity score matching (PSM) analysis was used to reduce selection bias. RESULTS: From 2004 to 2015, the rate of operation for HCC decreased in the localized group (P<0.001), the regional and distant group (P<0.001). Surgery rate in the localized, regional, and distant group also declined (P=0.016, P=0.009, and P=0.018, respectively). Non-operation rate increased in the localized, regional, and distant group (all P<0.001). The median overall survival (mOS) of patients in the localized, regional group who underwent surgery was longer than that of patients with non-surgical procedure and non-operation. Similar survival results were obtained in the analysis of patients with single tumor larger than 5 cm and 2–3 tumors larger than 3 cm. CONCLUSIONS: Although surgery rate declined from 2004 to 2015 in all HCC patients, it might be used more widely in patients with localized and regional tumors. And the treatment of surgery in patients with single tumor larger than 5 cm or patients with 2–3 tumors larger than 3 cm was worth trying.