title: The role of hepatic resection in the treatment of hepatocellular cancer.
abstract: Current guidelines recommend surgical resection as the primary treatment for a single hepatocellular cancer (HCC) with Child's A cirrhosis, normal serum bilirubin, and no clinically significant portal hypertension. We determined how frequently guidelines were followed and whether straying from them impacted survival. BRIDGE is a multiregional cohort study including HCC patients diagnosed between January 1, 2005 and June 30, 2011. A total of 8,656 patients from 20 sites were classified into four groups: (A) 718 ideal resection candidates who were resected; (B) 144 ideal resection candidates who were not resected; (C) 1,624 nonideal resection candidates who were resected; and (D) 6,170 nonideal resection candidates who were not resected. Median follow-up was 27 months. Log-rank and Cox's regression analyses were conducted to determine differences between groups and variables associated with survival. Multivariate analysis of all ideal candidates for resection (A+B) revealed a higher risk of mortality with treatments other than resection. For all resected patients (A+C), portal hypertension and bilirubin >1 mg/dL were not associated with mortality. For all patients who were not ideal candidates for resection (C+D), resection was associated with better survival, compared to embolization and "other" treatments, but was inferior to ablation and transplantation.
  
  
  CONCLUSIONS
  The majority of patients undergoing resection would not be considered ideal candidates based on current guidelines. Not resecting ideal candidates was associated with higher mortality. The study suggests that selection criteria for resection may be modestly expanded without compromising outcomes, and that some nonideal candidates may still potentially benefit from resection over other treatment modalities.
authors: North Shore-LIJ Health Systems, Lenox Hill Hospital, New York, NY.
authors: Sasan
authors: S
authors: Roayaie
authors: Brookdale's Medical Center, Department of Urology, Brooklyn, NY.
authors: Ghalib
authors: G
authors: Jibara
authors: Mount Sinai Medical Center, New York, NY.
authors: Parissa
authors: P
authors: Tabrizian
authors: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors: Joong-Won
authors: JW
authors: Park
authors: Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors: Jijin
authors: J
authors: Yang
authors: Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, China.
authors: Lunan
authors: L
authors: Yan
authors: Mount Sinai Medical Center, New York, NY.
authors: Myron
authors: M
authors: Schwartz
authors: Department of Hepatology and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
authors: Guohong
authors: G
authors: Han
authors: Hepatobiliary Unit, National Cancer Institute of Naples, G. Pascale Foundation, Naples, Italy.
authors: Francesco
authors: F
authors: Izzo
authors: Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors: Mishan
authors: M
authors: Chen
authors: Hepatology and Digestive Oncology Unit, Hôpital Saint-André, Bordeaux, France.
authors: Jean-Frédéric
authors: JF
authors: Blanc
authors: University of Liverpool, Liverpool, United Kingdom.
authors: Philip
authors: P
authors: Johnson
authors: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan.
authors: Masatoshi
authors: M
authors: Kudo
authors: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN.
authors: Lewis R
authors: LR
authors: Roberts
authors: University of Toronto and University Health Network, Toronto, Ontario, Canada.
authors: Morris
authors: M
authors: Sherman
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States