Published online May 24, 2022. doi: 10.5306/wjco.v13.i5.352
Peer-review started: December 25, 2021
First decision: March 16, 2022
Revised: March 29, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 24, 2022
Processing time: 149 Days and 13 Hours
Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare and distinct type of hepatocellular carcinoma.
Due to its rare nature, there is a limited understanding of factors affecting the survival outcomes.
This study aims to characterize the survival of FL-HCC by age, race, and surgical intervention.
FL-HCC patients were retrospectively identified with The Surveillance, Epidemiology, and End Results database. We conducted three separate survival analyses by age groups; ≤ 19, 20-59, and ≥ 60-year-old, and race; White, Black, Asian and Pacific Islanders (API), and Hispanic and surgical types; Wedge resection or segmental resection, lobectomy, extended lobectomy (lobectomy + locoregional therapy or resection of the other lobe), and transplant.
We identified 225 FL-HCC patients. Overall median survival was 34 (95%CI: 27-41) mo. Patients ≤ 19-year-old had more advanced disease with positive lymph nodes status. However, they received more surgical interventions. Survival months for ≤ 19 was 85 (95%CI: 37-137), 20-59 was 29 (95%CI: 18-41), and ≥ 60 was 12 (95%CI: 7-31) mo (P < 0.001). APIs lived in the area with a higher median household income, and Blacks lived in the area with a lower median household income. There were no differences in stages, lymph node status, metastasis status, and surgical treatment. Whites had 39 (95%CI: 29-63), Blacks 26 (95%CI: 5-92), Hispanics 31 (95%CI: 11-54), and APIs 28 (95%CI: 5-39) mo (P = 0.28). Of 225 patients, 111 FL-HCC patients had surgical procedures. Median survivals for a wedge or segmental resection was 112 (95%CI: 78-NA), lobectomy was 92 (95%CI: 57-NA), extended lobectomy was 54 (95%CI: 23-NA), and a transplant was 63 (95%CI: 20-NA) mo (P < 0.001). The median survival was better in patients who had surgical treatments regardless of lymph nodes or metastasis status (P < 0.001).
This study demonstrated a better survival of younger patients with FL-HCC, although they had aggressive diseases. There were no racial differences in survival for FL-HCC, which is seen in HCC. Surgical treatment provided better survival regardless of advanced disease.
This study can help healthcare professionals to guide FL-HCC patients about the outcome, especially after the surgical intervention. Further prospective studies are needed to elucidate in the era of personalized cancer therapy.