Wong LL, Hernandez BY, Shvetsov YB, Kawano Y, Tang ZY, Ji JF. Liver resection for early hepatocellular cancer: Comparison of centers in 3 different countries. World J Hepatol 2016; 8(31): 1327-1335 [PMID: 27872684 DOI: 10.4254/wjh.v8.i31.1327]
Corresponding Author of This Article
Linda L Wong, MD, Professor, Cancer Center, Department of Surgery, John A Burns School of Medicine, University of Hawaii, 550 South Beretania Street, Suite 403, Honolulu, HI 96813, United States. hepatoma@aol.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Nov 8, 2016; 8(31): 1327-1335 Published online Nov 8, 2016. doi: 10.4254/wjh.v8.i31.1327
Liver resection for early hepatocellular cancer: Comparison of centers in 3 different countries
Linda L Wong, Brenda Y Hernandez, Yurii B Shvetsov, Yoichi Kawano, Zhao-You Tang, Jun-Fang Ji
Linda L Wong, Brenda Y Hernandez, Yurii B Shvetsov, Cancer Center, Department of Surgery, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, United States
Yoichi Kawano, Department of Surgery, Nippon Medical School, Tokyo 113-0022, Japan
Zhao-You Tang, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai 200043, China
Jun-Fang Ji, Life Sciences Institute, Zhejiang University, Hangzhou 310058, Zhejiang Province, China
Author contributions: All the authors contributed to the manuscript.
Institutional review board statement: This study was reviewed and approved by the University of Hawaii Institutional Review Board. Data from Shanghai is from a cohort in which the anonymous data is publically available. Data from the Nippon Medical Center did not require Institutional review as it is retrospective anonymous data.
Informed consent statement: This is not applicable since this is a retrospective study. Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Dr Wong is a speaker for Bayer Healthcare. The other authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Linda L Wong, MD, Professor, Cancer Center, Department of Surgery, John A Burns School of Medicine, University of Hawaii, 550 South Beretania Street, Suite 403, Honolulu, HI 96813, United States. hepatoma@aol.com
Telephone: +1-808-5235033 Fax: +1-808-5284940
Received: May 13, 2016 Peer-review started: May 14, 2016 First decision: June 14, 2016 Revised: June 28, 2016 Accepted: August 15, 2016 Article in press: August 16, 2016 Published online: November 8, 2016 Processing time: 175 Days and 0.8 Hours
Abstract
AIM
To compare patients who underwent resection of early stage hepatocellular cancer (HCC) in three different countries.
METHODS
This retrospective study characterizes 573 stage I/II HCC patients treated with liver resection in 3 tertiary-referral centers: Tokyo (n = 250), Honolulu (n = 146) and Shanghai (n = 177).
RESULTS
Shanghai patients were younger, predominantly male, hepatitis-B seropositive (94%) and cirrhotic (93%). Tokyo patients were older and more likely to have hepatitis-C (67%), smaller tumors, low albumin, and normal alpha-fetoprotein. The Honolulu cohort had the largest tumors and 30% had no viral hepatitis. Age-adjusted mortality at 1 and 5-years were lower in the Tokyo cohort compared to Honolulu and there was no difference in mortality between Shanghai and Honolulu cohorts. Elevated alpha-fetoprotein, low albumin and tumor > 5 cm were associated with increased 1-year mortality. These factors and cirrhosis were independently associated with increased 5-year mortality. Independent risk factors of survival varied when examined separately by center.
CONCLUSION
The profile of early-stage HCC patients is strikingly different across countries and likely contributes to survival differences. Underlying differences in patient populations including risk factors/comorbidities influencing disease progression may also account for variation in outcomes.
Core tip: Treatment for hepatocellular cancer (HCC) depends on stage and liver function. Single-institution studies have characterized resection for HCC but this unique study combines the experience of three large hepatobiliary centers in different countries with 573 resections for stage I/II HCC in Tokyo (n = 250), Honolulu (n = 146) and Shanghai (n = 177). Groups differed in viral hepatitis, tumor size, alpha fetal protein (AFP) and cirrhosis. One and 5-year mortality was lowest in the Tokyo cohort. Elevated AFP, low albumin, tumor > 5 cm and cirrhosis were independently-associated with increased 5-year mortality. The profile of early-stage HCC patients is strikingly different across countries and likely contributes to survival differences.
