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Assessing the Survival Benefit of Surgery and Various Types of Radiation Therapy for Treatment of Hepatocellular Carcinoma: Evidence from the Surveillance, Epidemiology, and End Results Registries

Journal of Hepatocellular Carcinoma. 2020;Volume 7:201-218

 

Journal Homepage

Journal Title: Journal of Hepatocellular Carcinoma

ISSN: 2253-5969 (Online)

Publisher: Dove Medical Press

LCC Subject Category: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML

 

AUTHORS


Shi F

Wang C

Kong Y

Yang L

Li J

Zhu G

Guo J

Zheng Q

Zhang B

Wang S

EDITORIAL INFORMATION

Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 16 weeks

 

Abstract | Full Text

Fuyan Shi,1 Chen Wang,2 Yujia Kong,1 Liping Yang,3 Juan Li,1 Gaopei Zhu,1 Jing Guo,4 Qingfeng Zheng,5 Bo Zhang,6 Suzhen Wang1 1Department of Health Statistics, School of Public Health, Weifang Medical University, Weifang, Shandong 261053, People’s Republic of China; 2Department of Computer Science, Rutgers University, Piscataway, NJ 08854, USA; 3Center for Health and Medicine, Xijing Hospital, an Affiliated Hospital of Air Force Military Medical University, Xi’an, Shannxi 710032, People’s Republic of China; 4Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, People’s Republic of China; 5Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People’s Republic of China; 6Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, 02115, USACorrespondence: Bo Zhang; Suzhen Wang Email [email protected]; [email protected]: To evaluate the survival benefit of surgery and radiation for hepatocellular carcinoma (HCC) after adjusting for patient-specific and tumor-specific factors.Methods: This study analyzed HCC patients who enrolled in the Surveillance, Epidemiology, and End Results (SEER) registry between January 2004 and December 2013. Of the 5552 HCC patients, 4597 received surgery and 955 received radiation. Patients who received radiation were further divided into 3 subgroups: 541 who received beam radiation (BR), 197 who received radioactive implants (RI), and 217 who received radioisotopes (RIT). Propensity score weighting analysis derived from generalized boosted models (GBMs) was performed to ensure well-balanced characteristics in all comparison groups.Results: Overall survival rates and HCC-specific survival rates were higher in those receiving surgery compared with those receiving radiotherapy. This was confirmed by Cox proportional hazard regression both before and after inverse probability of treatment weighting (IPTW). Before IPTW, the RIT group had a better outcome than the BR group in terms of overall and HCC-specific survival rates, but there was no significant difference between the RI and BR groups. After IPTW, Cox proportional hazard regression demonstrated that both the RIT and RI groups had higher survival rates than the BR group.Conclusion: In HCC patients, surgery was associated with higher survival rates compared with radiotherapy while adjusting for other factors. Among those who received radiotherapy, RIT and RI granted survival benefits.Keywords: hepatocellular carcinoma, survival analysis, propensity score, generalized boosted models, inverse probability of treatment weighting, Cox proportional hazard models