The chances of hepatic resection curing hepatocellular carcinoma.

BACKGROUND AIMS:The popular sense of the word "cure" implies that a patient treated for a specific disease will return to have the same life-expectancy as if he/she had never had the disease. In analytic terms, it translates into the concept of statistical cure which occurs when a group of patients returns to having similar mortality to a reference population. Aim of the study was to assess the probability of being cured from hepatocellular carcinoma (HCC) by hepatic resection. METHODS:Data from 2523 patients undergoing resection for HCC were used to fit statistical cure models to compare disease-free survival (DFS) after surgery to survival expected for chronic hepatitis - cirrhotic patients and the general population, matched by sex, age, race/ethnicity and year of diagnosis. RESULTS:The probability of resection to provide the same life-expectancy of patients with chronic hepatitis - cirrhosis, was 26.3%. The conditional probability to achieve this result was time-dependent, requiring about 8.9 year for being accomplished with 95% certainty. Considering the general population as reference, the cure fraction decreased to 17.1%. Uncured patients had a median DFS of 1.5 years. In multi-variable analysis, patient's age and the risk for early HCC recurrence (within 2 years) were independent determinants of the chance of cure (p