title: Surgical resection in hepatocellular carcinoma patients with minimal background fibrosis: a strategy in the era of organ shortage.
abstract: BACKGROUND
  Surgical therapies for hepatocellular carcinoma (HCC) represent the potentially curative approaches and provide patients the greatest survival advantage. We sought to examine the outcomes of patients with HCC treated with surgical resection, transplantation, and local ablation.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database was queried for all patients with nonmetastatic HCC from 2004 to 2007 who underwent local ablation (LA), segmental resection (SR), hemihepatectomy or extended resection (ER), or transplantation (TP).
  
  
  RESULTS
  Of 16,209 patients with HCC, 3,989 (24.6 %) met criteria for inclusion and received therapies: 1,550 LA (39 %), 703 SR (18 %), 619 ER (16 %), and 1,117 TP (28 %). AFP was elevated in 69 % (2,026 of 2,921), and fibrosis grade 0-4 was noted in 32 % (368 of 1,156). The 3-year survival by procedure was 34 % (LA), 50 % (SR), 54 % (ER), and 74 % (TP), p = .001. In patients with minimal fibrosis, 1-year survival for patients undergoing resection was similar to TP (85 vs. 92 %, p = .346), but greater than LA (69 %, p = .001).
  
  
  CONCLUSIONS
  Survival after surgical resection for HCC patients without extensive fibrosis appears to be superior to ablation and non-inferior to transplantation. In an era of organ shortage, transplantation may be better reserved for patients with cirrhosis and/or unresectable disease.
authors: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. rgroesch@mcw.edu
authors: Ryan T
authors: RT
authors: Groeschl
authors: T
authors: T
authors: Clark Gamblin
authors: Kiran K
authors: KK
authors: Turaga
mesh_terms: D055011:Ablation Techniques / Q000706:statistics & numerical data*; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D012720:Severity of Illness Index; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins