Introduction: Small studies from outside of the USA suggest excellent outcomes after surgical resection for hepatocellular carcinoma (HCC) with vascular invasion. The study aims to (1) compare overall survival after surgical resection and systemic therapy among patients with HCC and vascular invasion and (2) determine factors associated with receipt of surgical resection in a US population. Methods: HCC patients with AJCC clinical TNM stage 7th T3BN0M0 diagnosed between 2010 and 2017 from the National Cancer Database were analyzed. Cox and logistic regression analyses identified factors associated with overall survival and receipt of surgical resection. Results: Of 11,259 patients with T3BN0M0 HCC, 325 (2.9%) and 4,268 (37.9%) received surgical resection and systemic therapy, respectively. In multivariable analysis, surgical resection was associated with improved survival compared to systemic therapy (adjusted hazard ratio: 0.496, 95% confidence interval: 0.426–0.578) with a median survival of 21.4 and 8.1 months, respectively. Superiority of surgical resection was observed in noncirrhotic and cirrhotic subgroups and propensity score matching and inverse probability of treatment weighting adjusted analysis. Asians were more likely to receive surgical resection, whereas Charlson comorbidity ≥3, elevated alpha-fetoprotein, smaller tumor size, care in a community cancer program, and the South or West region were associated with a lower likelihood of surgical resection. Conclusion: HCC patients with vascular invasion may benefit from surgical resection compared to systemic therapies. Demographic and clinical features of HCC patients and region and type of treating facility were associated with surgical resection versus systemic treatment.
Liver Cancer

中文翻译：

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肝细胞癌合并血管浸润的手术切除和全身治疗的比较：国家癌症数据库分析

简介：来自美国以外的小型研究表明，手术切除伴血管侵犯的肝细胞癌 (HCC) 后可取得良好的结果。该研究旨在 (1) 比较患有 HCC 和血管侵犯的患者在手术切除和全身治疗后的总体存活率，以及 (2) 确定与美国人群接受手术切除相关的因素。方法：对国家癌症数据库中 2010 年至 2017 年间诊断为 AJCC 临床 TNM 7 期 T3BN0M0 的 HCC 患者进行分析。Cox 和逻辑回归分析确定了与总生存期和接受手术切除相关的因素。结果：在 11,259 名 T3BN0M0 HCC 患者中，分别有 325 名（2.9%）和 4,268 名（37.9%）接受了手术切除和全身治疗。在多变量分析中，与全身治疗相比，手术切除与改善生存率相关（调整后的风险比：0.496，95% 置信区间：0.426-0.578），中位生存期分别为 21.4 个月和 8.1 个月。在非肝硬化和肝硬化亚组以及倾向评分匹配和治疗加权调整分析的逆概率中观察到手术切除的优势。亚洲人更有可能接受手术切除，而 Charlson 合并症≥3、甲胎蛋白升高、肿瘤体积较小、社区癌症项目的护理以及南部或西部地区与手术切除的可能性较低有关。结论：与全身治疗相比，血管侵犯的 HCC 患者可能受益于手术切除。HCC 患者的人口统计学和临床​​特征以及治疗设施的地区和类型与手术切除与全身治疗相关。
肝癌