Liver Resection Combined with Radiotherapy versus Liver Resection Alone in the Treatment of Hepatocellular Carcinoma: A Population-based Study

Abstract

BackgroundRadiotherapy has been used in the treatment of hepatocellular carcinoma (HCC) more widely. However, little research focus on comparing the efficacy of patients with liver resection combined with radiotherapy with that received liver resection alone. The study was conducted to evaluate whether the efficacy of liver resection combined with radiotherapy in the treatment of patients with HCC is better than liver resection alone.MethodsThe study utilized the data from the Surveillance, Epidemiology, and End Results 18 registry (SEER-18). Patients diagnosed with HCC between 2004 and 2015 who received liver resection or the combination of liver resection and radiotherapy were included in the analysis. The propensity score matching model (PSM) was used to reduce selection bias and potential confounding factors.ResultsBefore PSM, the median overall survival (mOS) and median cancer-specific survival (mCSS) of patients treated with liver resection alone were longer than in patients treated with the combination of liver resection and radiotherapy (P<0.001). However, there was no statistically significant difference in mOS and mCSS between the groups after PSM (P>0.05). The subgroup analysis after PSM documented that patients with American Joint Committee on Cancer (AJCC) stage I and II who were treated with liver resection and radiotherapy had no longer mOS and mCSS than patients subjected to the combination of liver resection alone (P=0.151 and P=0.185). Similar results were obtained in the subgroup group of patients with a single tumor smaller than 5 cm. Univariate analysis showed that patients undergoing liver resection combined with radiotherapy did not have an increased all-cause mortality risk (HR:1.214, 95%CI: 0.950-1.553; P=0.122) and cancer-specific mortality risk (HR:1.132, 95%CI: 0.848-1.510; P=0.401) when compared to patients treated with liver resection alone after PSM.ConclusionThe combination of liver resection and radiotherapy does not prolong the survival of HCC patients more than liver resection alone.