Fibrosis score impacts survival following resection for hepatocellular carcinoma (HCC): A Surveillance, End Results and Epidemiology (SEER) database analysis

Background/Objectives: Surgical extirpation for hepatocellular carcinoma (HCC) with background fibrosis remains a challenge. This study evaluated impact of fibrosis score on long term outcomes of patients undergoing surgical resection for HCC. Methods: Using the Surveillance, Epidemiology and End Results (SEER) database (2004-2013), complete data on 1433 patients undergoing surgical resection for non-metastatic HCC were identified. Overall survival (OS) was estimated using the Kaplan-Meier method. Cox proportional hazards model were used to produce adjusted hazard ratios (HR). Results: In this study, 54% (650/1433) patients had F5-6 fibrosis at the time for surgical resection of HCC. In adjusted models, F5/6 fibrosis significantly reduces overall survival (HR: 1.62, 95% CI: 1.34-1.94; p < 0.001). Median survival was significantly longer for patients with F0-4 fibrosis for T1a, T1b and T2 tumours as compared to F5-6 fibrosis, not for T3 and T4 tumours, even when stratified by extent of hepatectomy. There were no significant differences in 90-day post-operative mortality between fibrosis groups when stratified by T-classifications. Conclusion: Liver resection in patients with advanced fibrosis has significantly lower survival as compared to patients with F0-4 fibrosis in early stage (T1 and T2), not advanced tumours (T3 and T4). Improvement in patient selection and perioperative care for liver resection may offer consistent and clinically meaningful long-term survival in HCC. (C) 2018 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.