Surgical therapy and survival in young patients with stage I–II hepatocellular carcinoma: a retrospective cohort study

BACKGROUND: Hepatocellular carcinoma (HCC) is regarded as a high-mortality cancer, but the effectiveness of surgical strategies for young patients with early-stage HCC remains controversial. We aimed to analyze the survival in young patients with stage I–II HCC who underwent different kinds of surgical treatments. METHODS: Overall survival (OS) and cancer-specific survival (CSS) were compared among patients aged 18–45 years with stage I–II HCC from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2013) who underwent local tumor destruction (LTD), wedge or segmental resection (WSR), lobectomy resection (LR), liver transplantation (LT), or non-surgery. Univariate and multivariate analyses and Kaplan-Meier method were used to examine the OS and CSS of the patients. A stratification analysis of CSS was also conducted among the subgroups. RESULTS: Data from 664 patients were extracted. The median survival time was 46 months. In the multivariate analysis of OS, compared with non-surgery, LTD [hazard ratio (HR), 0.37; 95% confidence interval (CI): 0.25–0.54; P<0.0001], LR (HR, 0.29; 95% CI: 0.19–0.45; P<0.0001), and WSR (HR, 0.26; 95% CI: 0.17–0.39; P<0.0001) had better outcomes, and LT had the best survival benefit (HR, 0.24; 95% CI: 0.16–0.36; P<0.0001), which was similar to CSS. In the stratification analysis, compared with the non-surgery group, among patients with chemotherapy, LT reduced the risk of CSS by 64% (HR, 0.36; 95% CI: 0.19–0.66; P interaction=0.0004). CONCLUSIONS: Surgery offers a survival benefit compared with non-surgery for young patients with stage I–II HCC. LT is associated with better survival than WSR, LR, and LTD.