Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Improved Survival Outcomes with Surgical Resection Compared to Ablative Therapy in Early-Stage HCC: A Large, Real-World, Propensity-Matched, Multi-Centre, Australian Cohort Study (#430)

Jonathan Abdelmalak 1 2 3 , Simone Strasser 4 , Natalie Ngu 4 , Claude Dennis 4 , Marie Sinclair 3 , Avik Majumdar 3 , Kate Collins 3 , Katherine Bateman 3 , Anouk Dev 5 , Joshua Abasszade 5 , Zina Valaydon 6 , Daniel Saitta 6 , Kathryn Gazelakis 6 , Susan Byers 6 , Jacinta Holmes 7 8 , Alexander Thompson 7 8 , Dhivya Pandiaraja 7 , Steven Bollipo 9 , Suresh Sharma 9 , Merlyn Joseph 9 , Rohit Sawhney 10 11 , Amanda Nicoll 10 11 , Nicholas Batt 10 , Myo Tang 2 , Stephen Riordan 12 , Nicholas Hannah 13 , James Haridy 13 , Siddharth Sood 13 , Eileen Lam 1 , Elysia Greenhill 1 , Liane Ioannou 1 , John Lubel 1 2 , William Kemp 1 2 , Ammar Majeed 1 2 , John Zalcberg 1 2 , Stuart Roberts 1 2
  1. Monash University, Melbourne, VIC, Australia
  2. Alfred Health, Melbourne, VIC, Australia
  3. Gastroenterology, Austin Hospital, Melbourne, VIC, Australia
  4. AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  5. Gastroenterology, Monash Health, Melbourne, VIC, Australia
  6. Gastroenterology, Western Health, Melbourne, VIC, Australia
  7. Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
  8. Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC, Australia
  9. Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW , Australia
  10. Gastroenterology, Eastern Health, Melbourne, VIC, Australia
  11. Medicine, Eastern Health Clinical School, Melbourne, VIC, Australia
  12. Gastroenterology, Prince of Wales Hospital, Randwick, NSW, Australia
  13. Gastroenterology, Royal Melbourne Hospital, Melbourne, VIC, Australia

The optimal treatment approach in very-early and early-stage hepatocellular carcinoma (HCC) is not precisely defined, with ambiguity in the literature around the comparative efficacy of surgical resection versus ablation as curative therapies for limited disease. We performed this real-world propensity-matched, multi-centre cohort study to assess for differences in survival outcomes between those undergoing resection and those receiving ablation.

 

Patients with Barcelona Clinic Liver Cancer (BCLC) 0/A HCC first diagnosed between 01/01/2016 and 31/12/2020 who received ablation or resection as initial treatment were included in the study.

 

A total of 450 patients were included in the study from 10 major liver centres including two transplant centres. Patients who underwent resection were systematically different to those who received ablation, with significant differences seen in age, managing centre, liver disease aetiology, diabetes, platelet count, Charlson Comorbidity Index (CCI) tumour burden and Child Pugh score, Propensity-score matching was performed using key covariates producing 156 patients available for analysis with 78 in each group. Over a median follow up of 53.3 months, patients who underwent resection had significantly improved overall survival (97.4% vs 88.5%, log-rank test p=0.023) with similar results in the original unmatched cohort (94.9% vs 83.9%, log-rank test p<0.001). Local recurrence-free survival was superior in the resection group (88.5% vs 76.7%, log-rank test p=0.027) over a median follow-up of 37.9 months with similar superior 3-year recurrence-free survival (75.6% vs 57.5%, log-rank test p=0.007). Major complication rate was low in the original unmatched resection group who had been selected for surgery by a real-world multidisciplinary group of expert clinicians (2 out of 196, 1.0%).

 

Our study suggests that surgical resection results in more durable local tumour control in BCLC 0/A HCC as compared to ablation which translates to improved survival outcomes.