Long-term outcomes in patients undergoing resection, ablation, and trans-arterial chemoembolization of hepatocellular carcinoma in the United States: a national cancer database analysis

In the United States, hepatocellular carcinoma (HCC) incidence rates were approximately three times higher in over 30 years. To investigate the long-term outcomes of patients who underwent resection, ablation, and trans-arterial chemoembolization (TACE) of HCC, we analyzed the National Cancer Data Base (NCDB), which is a nationwide oncology outcomes database and covers approximately 70% of new cancer cases in the United States. A total of 56,512 patients with HCC in the NCDB during 2004-2013 were retrospectively analyzed. Results showed that liver resection (48.5%) and ablation (57.0%) were performed more frequently than TACE (31.5%) in patients with AJCC stage I HCC. The 5-year overall survival (OS) was significantly higher in patients undergoing resection (52.4%) than in patients undergoing ablation (40.5%; P < 0.001) and patients undergoing TACE (36.1%; P < 0.001). For patients with AJCC stage I, the 5-year OS of patients undergoing resection (51.6%; P < 0.001) and patients undergoing ablation (51.1%, P = 0.005) remains significantly better than patients undergoing TACE (40.0%). However, the 5-year OS did not differ significantly between patients undergoing resection and patients undergoing ablation (P = 0.486). Additionally, the findings of our study confirm that the sub-stratification of T1 category by HCC diameter in the AJCC staging eighth edition (i.e., T1a, HCC diameter <= 2 cm and T1b, HCC diameter > 2 cm) is valid, with a 5-year OS of 54.1% and 50.4%, respectively (P = 0.031).