Effects of Curative-Intent Treatments on Hepatocellular Carcinoma Survival in Alcohol-Related Cirrhosis: A Nationwide Study

Abstract

Purpose

The aim of curative-intent treatment for hepatocellular carcinoma (HCC) is to restore the patients’ survival to what it would have been, had they not developed HCC. We examined the chances of such ‘statistical cure’ from HCC in patients with cirrhosis due to alcohol-related liver disease (ALD cirrhosis).

Patients and Methods

Using nationwide Danish healthcare registries, all patients with ALD cirrhosis who were treated for HCC in 2004–2018 were identified and included in cohorts based on initial HCC treatment. We used cure fraction analyses to estimate the chance of being statistically cured by each HCC treatment.

Results

We included 1087 patients with HCC due to ALD cirrhosis, of whom 51 (4.7%) were treated with resection and 215 (19.8%) were treated with ablation. The cure fraction, ie the fraction of patients who experienced no excess mortality from HCC, was 31.8% (95% CI: 0.0−67.5) following resection and 22.9% (95% CI: 2.6−43.2) following ablation. In patients who were still alive five years after the initial HCC treatment, the likelihood of having been statistically cured at that time was 69.0% after resection and 60.2% after ablation. For both treatments, a 90% chance of having been statistically cured was reached after seven years.

Conclusion

Based on cure fraction analyses, resection for HCC statistically cures 31.8% of patients with HCC and underlying ALD cirrhosis, while ablation statistically cures 22.9% of patients. Seven years after curative-intent treatments for HCC, surviving patients are 90% likely to be statistically cured of HCC. This information is valuable to patients and the clinicians caring for them.

Keywords:

• carcinoma
• hepatocellular
• liver diseases
• alcoholic
• hepatectomy
• catheter ablation

Abbreviations

HCC, hepatocellular carcinoma; ALD cirrhosis, cirrhosis due to alcohol-related liver disease; ICD, International Classification of Diseases; NCSP, NOMESCO Classification of Surgical Procedures; EASL, The European Association for the Study of the Liver; TACE, transarterial chemoembolisation; SIRT, selective internal radiation therapy; SBRT, stereotactic body radiation therapy; MR, magnetic resonance imaging; CT, computed tomography; CI, confidence interval; PPV, positive predictive value.

Data Sharing Statement

The data used in this study cannot be made publicly available according to Danish law. Access to data from the Danish healthcare registries can be applied for via https://sundhedsdatastyrelsen.dk/da/forskerservice.

Ethics Approval and Informed Consent

This study was approved by the National Board of Health and by the Danish Data Protection Agency (Journal No. 1-16-02-321-19). According to the Danish law, approval from the Danish Committee on Health Research Ethics was not necessary. Since this is a register-based study, written consent was not required.

Consent for Publication

All content in this manuscript is original, and all authors have seen and agreed to the publication of the final draft.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

Peter Jepsen was supported by a grant from the Novo Nordisk Foundation (NNF18OC0054612). The funding organization was not involved in the design and conduct of the study, or in the decision to submit the manuscript for publication. All other authors report no financial support.