Treatment and prognosis of patients with fibrolamellar hepatocellular carcinoma: A national perspective

Skye C. Mayo, Michael N. Mavros, Hari Nathan, David Cosgrove, Joseph M. Herman, Ihab R Kamel, Robert A Anders, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background Surgery remains the only potentially curative option for patients with hepatocellular carcinoma (HCC) and fibrolamellar carcinoma (FLC). We sought to investigate the differences over time in surgically managed FLC compared with conventional HCC using population-based data. Study Design Using SEER data, we identified 7,225 patients with surgically managed FLC or HCC from 1986 to 2008. We examined differences in clinicopathologic and surgical factors associated with long-term survival. Results Of the 7,225 patients, the majority had HCC (n = 7,135; 99%) vs FLC (n = 90; 1%). Patients with FLC were younger (25 years vs 59 years) and more often were women (44% vs 27%) than patients with HCC (both p <0.001). Regional disease was more common among patients with FLC (42.2%) vs patients with HCC (22.1%) (p <0.001). More than one-third of patients with FLC (36.9%) were operatively managed with a hemihepatectomy compared with patients with HCC, who were more often managed with a liver transplant (p <0.001). On univariable analysis, there was a marked difference in overall survival, with patients with FLC surviving a median of 75 months vs 43 months for HCC (hazard ratio [HR]: 0.59; p = 0.001). There was a marked difference in survival when patients were stratified by localized (FLC, 78 months vs HCC, 49 months; p = 0.012) vs regional disease (FLC, 46 months vs HCC, 23 months; p = 0.002. Conclusions Patients with FLC have many clinicopathologic features that are different from those of patients with HCC, including younger age and female sex. Despite a higher likelihood of advanced disease at the time of diagnosis, surgically treated FLC patients had better long-term outcomes than patients with conventional HCC.

Original languageEnglish (US)
Pages (from-to)196-205
Number of pages10
JournalJournal of the American College of Surgeons
Volume218
Issue number2
DOIs
StatePublished - Feb 2014

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Hepatocellular Carcinoma
Carcinoma
Therapeutics
Fibrolamellar hepatocellular carcinoma
Survival
Transplants
Liver

ASJC Scopus subject areas

  • Surgery

Cite this

Treatment and prognosis of patients with fibrolamellar hepatocellular carcinoma : A national perspective. / Mayo, Skye C.; Mavros, Michael N.; Nathan, Hari; Cosgrove, David; Herman, Joseph M.; Kamel, Ihab R; Anders, Robert A; Pawlik, Timothy M.

In: Journal of the American College of Surgeons, Vol. 218, No. 2, 02.2014, p. 196-205.

Research output: Contribution to journalArticle

Mayo, Skye C. ; Mavros, Michael N. ; Nathan, Hari ; Cosgrove, David ; Herman, Joseph M. ; Kamel, Ihab R ; Anders, Robert A ; Pawlik, Timothy M. / Treatment and prognosis of patients with fibrolamellar hepatocellular carcinoma : A national perspective. In: Journal of the American College of Surgeons. 2014 ; Vol. 218, No. 2. pp. 196-205.
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title = "Treatment and prognosis of patients with fibrolamellar hepatocellular carcinoma: A national perspective",
abstract = "Background Surgery remains the only potentially curative option for patients with hepatocellular carcinoma (HCC) and fibrolamellar carcinoma (FLC). We sought to investigate the differences over time in surgically managed FLC compared with conventional HCC using population-based data. Study Design Using SEER data, we identified 7,225 patients with surgically managed FLC or HCC from 1986 to 2008. We examined differences in clinicopathologic and surgical factors associated with long-term survival. Results Of the 7,225 patients, the majority had HCC (n = 7,135; 99{\%}) vs FLC (n = 90; 1{\%}). Patients with FLC were younger (25 years vs 59 years) and more often were women (44{\%} vs 27{\%}) than patients with HCC (both p <0.001). Regional disease was more common among patients with FLC (42.2{\%}) vs patients with HCC (22.1{\%}) (p <0.001). More than one-third of patients with FLC (36.9{\%}) were operatively managed with a hemihepatectomy compared with patients with HCC, who were more often managed with a liver transplant (p <0.001). On univariable analysis, there was a marked difference in overall survival, with patients with FLC surviving a median of 75 months vs 43 months for HCC (hazard ratio [HR]: 0.59; p = 0.001). There was a marked difference in survival when patients were stratified by localized (FLC, 78 months vs HCC, 49 months; p = 0.012) vs regional disease (FLC, 46 months vs HCC, 23 months; p = 0.002. Conclusions Patients with FLC have many clinicopathologic features that are different from those of patients with HCC, including younger age and female sex. Despite a higher likelihood of advanced disease at the time of diagnosis, surgically treated FLC patients had better long-term outcomes than patients with conventional HCC.",
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T1 - Treatment and prognosis of patients with fibrolamellar hepatocellular carcinoma

T2 - A national perspective

AU - Mayo, Skye C.

AU - Mavros, Michael N.

AU - Nathan, Hari

AU - Cosgrove, David

AU - Herman, Joseph M.

AU - Kamel, Ihab R

AU - Anders, Robert A

AU - Pawlik, Timothy M.

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N2 - Background Surgery remains the only potentially curative option for patients with hepatocellular carcinoma (HCC) and fibrolamellar carcinoma (FLC). We sought to investigate the differences over time in surgically managed FLC compared with conventional HCC using population-based data. Study Design Using SEER data, we identified 7,225 patients with surgically managed FLC or HCC from 1986 to 2008. We examined differences in clinicopathologic and surgical factors associated with long-term survival. Results Of the 7,225 patients, the majority had HCC (n = 7,135; 99%) vs FLC (n = 90; 1%). Patients with FLC were younger (25 years vs 59 years) and more often were women (44% vs 27%) than patients with HCC (both p <0.001). Regional disease was more common among patients with FLC (42.2%) vs patients with HCC (22.1%) (p <0.001). More than one-third of patients with FLC (36.9%) were operatively managed with a hemihepatectomy compared with patients with HCC, who were more often managed with a liver transplant (p <0.001). On univariable analysis, there was a marked difference in overall survival, with patients with FLC surviving a median of 75 months vs 43 months for HCC (hazard ratio [HR]: 0.59; p = 0.001). There was a marked difference in survival when patients were stratified by localized (FLC, 78 months vs HCC, 49 months; p = 0.012) vs regional disease (FLC, 46 months vs HCC, 23 months; p = 0.002. Conclusions Patients with FLC have many clinicopathologic features that are different from those of patients with HCC, including younger age and female sex. Despite a higher likelihood of advanced disease at the time of diagnosis, surgically treated FLC patients had better long-term outcomes than patients with conventional HCC.

AB - Background Surgery remains the only potentially curative option for patients with hepatocellular carcinoma (HCC) and fibrolamellar carcinoma (FLC). We sought to investigate the differences over time in surgically managed FLC compared with conventional HCC using population-based data. Study Design Using SEER data, we identified 7,225 patients with surgically managed FLC or HCC from 1986 to 2008. We examined differences in clinicopathologic and surgical factors associated with long-term survival. Results Of the 7,225 patients, the majority had HCC (n = 7,135; 99%) vs FLC (n = 90; 1%). Patients with FLC were younger (25 years vs 59 years) and more often were women (44% vs 27%) than patients with HCC (both p <0.001). Regional disease was more common among patients with FLC (42.2%) vs patients with HCC (22.1%) (p <0.001). More than one-third of patients with FLC (36.9%) were operatively managed with a hemihepatectomy compared with patients with HCC, who were more often managed with a liver transplant (p <0.001). On univariable analysis, there was a marked difference in overall survival, with patients with FLC surviving a median of 75 months vs 43 months for HCC (hazard ratio [HR]: 0.59; p = 0.001). There was a marked difference in survival when patients were stratified by localized (FLC, 78 months vs HCC, 49 months; p = 0.012) vs regional disease (FLC, 46 months vs HCC, 23 months; p = 0.002. Conclusions Patients with FLC have many clinicopathologic features that are different from those of patients with HCC, including younger age and female sex. Despite a higher likelihood of advanced disease at the time of diagnosis, surgically treated FLC patients had better long-term outcomes than patients with conventional HCC.

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