Ablation for Hepatocellular Carcinoma: Validating the 3-cm Breakpoint
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Although many previous studies on local ablation outcomes for hepatocellular carcinoma (HCC) have dichotomized tumor size with a 3-cm cutoff to determine prognostic significance, a growing number of reports describe excellent outcomes for larger tumors. To address the logic of this 3-cm cutoff beyond small single-center experiences, we stratified patients by 1-cm tumor size intervals and hypothesized that disease-specific survival (DSS) would not vary significantly between adjacent groups.
Patients treated with local ablation for T1 HCC (≤8 cm) were identified from the surveillance, epidemiology, and end results database (2004–2008). Log-rank tests and multivariable Cox proportional hazards models were used to compare DSS curves of adjacent study groups.
There were 1,083 patients included in the study (26 % female, median age: 62 years). The 3-year DSS was significantly lower in patients with 3- to 4-cm tumors compared to 2- to 3-cm tumors (58 vs. 72 %, p = 0.002). In adjusted models, DSS did not vary significantly between any size intervals up to 3 cm. Patients with 3- to 4-cm tumors, however, had a poorer prognosis compared with patients with 2- to 3-cm tumors (hazard ratio: 1.6, 95 % confidence interval: 1.18–2.18, p = 0.002). DSS also fell when tumor size increased from 5–6 to 6–7 cm (53 vs. 21 %, 0.006).
This study emphasizes the 3-cm size, and possibly the 6-cm size, as informative predictive thresholds when ablating HCC, because variability of DSS occurred specifically at these tumor sizes. Future research in this field should either adopt a 3-cm breakpoint or provide evidence for alternative thresholds.
KeywordsOverall Survival Median Tumor Size Underlying Liver Disease Ablation Outcome Provider Experience
Conflict of interest
Dr. Gamblin would like to disclose an active consulting agreement with Covidien.
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