Published online Nov 8, 2016. doi: 10.4254/wjh.v8.i31.1327
Peer-review started: May 14, 2016
First decision: June 14, 2016
Revised: June 28, 2016
Accepted: August 15, 2016
Article in press: August 16, 2016
Published online: November 8, 2016
To compare patients who underwent resection of early stage hepatocellular cancer (HCC) in three different countries.
This retrospective study characterizes 573 stage I/II HCC patients treated with liver resection in 3 tertiary-referral centers: Tokyo (n = 250), Honolulu (n = 146) and Shanghai (n = 177).
Shanghai patients were younger, predominantly male, hepatitis-B seropositive (94%) and cirrhotic (93%). Tokyo patients were older and more likely to have hepatitis-C (67%), smaller tumors, low albumin, and normal alpha-fetoprotein. The Honolulu cohort had the largest tumors and 30% had no viral hepatitis. Age-adjusted mortality at 1 and 5-years were lower in the Tokyo cohort compared to Honolulu and there was no difference in mortality between Shanghai and Honolulu cohorts. Elevated alpha-fetoprotein, low albumin and tumor > 5 cm were associated with increased 1-year mortality. These factors and cirrhosis were independently associated with increased 5-year mortality. Independent risk factors of survival varied when examined separately by center.
The profile of early-stage HCC patients is strikingly different across countries and likely contributes to survival differences. Underlying differences in patient populations including risk factors/comorbidities influencing disease progression may also account for variation in outcomes.
Core tip: Treatment for hepatocellular cancer (HCC) depends on stage and liver function. Single-institution studies have characterized resection for HCC but this unique study combines the experience of three large hepatobiliary centers in different countries with 573 resections for stage I/II HCC in Tokyo (n = 250), Honolulu (n = 146) and Shanghai (n = 177). Groups differed in viral hepatitis, tumor size, alpha fetal protein (AFP) and cirrhosis. One and 5-year mortality was lowest in the Tokyo cohort. Elevated AFP, low albumin, tumor > 5 cm and cirrhosis were independently-associated with increased 5-year mortality. The profile of early-stage HCC patients is strikingly different across countries and likely contributes to survival differences.