title: Hepatocellular carcinoma surgery outcomes in the developing world: A 20-year retrospective cohort study at the National Cancer Institute of Peru.
abstract: In the developing world, most patients with hepatocellular carcinoma present with advanced-stage disease, considered to be incurable based on current therapeutic algorithms. Here, we demonstrate that curative liver resection is achievable in a portion of Peruvian patients not addressed by these treatment algorithms. We conducted a retrospective cohort study of 253 hepatocellular carcinoma patients that underwent a curative hepatectomy between 1991 and 2011 at the National Cancer Institute of Peru. The median age of the cohort was 36 years, and merely 15.4% of the patients displayed cirrhosis. The average tumor size was over 14 cm in diameter, resulting in 76.3% of major hepatectomies performed. The 5- and 10-year survival probability estimates were 37.5% and 26.2%, respectively. Age (>44 vs. ≤44 years old; P = 0.005), tumor size (>10 cm vs. ≤10 cm in diameter; P = 0.009), cirrhosis (P < 0.001), satellite lesions (P < 0.001), macroscopic vascular invasion (P < 0.001), allogeneic blood transfusion (P = 0.011), and spontaneous rupture of the tumor (P = 0.006) were independent predictive factors for prognosis. Hepatocellular carcinomas in Peru are characterized by a distinct clinical presentation with notable features compared with those typically described throughout relevant literature. Despite a large number of advanced-stage hepatocellular carcinomas, the outcomes of liver resection observed in the present study were in good standing with the results previously described in other series. It thus appears that staging systems and associated therapeutic algorithms designed for use in the developed world remain inadequate in certain populations, especially in the context of Peruvian patients. Our findings suggest that clinicians in the developing world should reconsider management guidelines pertaining to hepatocellular carcinoma. Indeed, we hypothesize that, in developing countries, a strict adherence to these therapeutic algorithms might create a selection bias resulting in the dismissal of patients who could eventually be treated.
authors.affiliation: Instituto Nacional de Enfermedades Neoplásicas, Departamento de Cirugía en Abdomen, Lima, Peru.
authors.forename: Eloy
authors.initials: E
authors.lastname: Ruiz
authors.affiliation: Aix Marseille Université, UMR912 SESSTIM INSERM-IRD-AMU, Centre d'Epidémiologie et de Santé Publique des Armées, Marseille, France.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rojas Rojas
authors.affiliation: Instituto Nacional de Enfermedades Neoplásicas, Departamento de Cirugía en Abdomen, Lima, Peru.
authors.forename: Francisco
authors.initials: F
authors.lastname: Berrospi
authors.affiliation: Instituto Nacional de Enfermedades Neoplásicas, Departamento de Cirugía en Abdomen, Lima, Peru.
authors.forename: Ivan
authors.initials: I
authors.lastname: Chávez
authors.affiliation: Instituto Nacional de Enfermedades Neoplásicas, Departamento de Cirugía en Abdomen, Lima, Peru.
authors.forename: Carlos
authors.initials: C
authors.lastname: Luque
authors.affiliation: Instituto Nacional de Enfermedades Neoplásicas, Departamento de Patología, Lima, Peru.
authors.forename: Luis
authors.initials: L
authors.lastname: Cano
authors.affiliation: Instituto Nacional de Enfermedades Neoplásicas, Departamento de Patología, Lima, Peru.
authors.forename: Franco
authors.initials: F
authors.lastname: Doimi
authors.affiliation: Institut Pasteur, Unité Organisation Nucléaire et Oncogenèse, Paris, France; Institut National de la Santé et de la Recherche Médicale, Paris U993, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Pineau
authors.affiliation: Université de Toulouse, UPS, UMR152 PHARMADEV, Université Toulouse 3, Toulouse, France; Institut de Recherche pour le Développement, UMR152 PHARMADEV, Vientiane, Laos.
authors.forename: Eric
authors.initials: E
authors.lastname: Deharo
authors.affiliation: Université de Toulouse, UPS, UMR152 PHARMADEV, Université Toulouse 3, Toulouse, France; Institut de Recherche pour le Développement, UMR152 PHARMADEV, Lima, Peru.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bertani
keywords: Cancer; Health sciences; Pathobiology of cancer; Treatment of cancer