Life expectancy of patients with hepatocellular carcinoma according to the upfront treatment: A nationwide analysis

Purpose : The purpose of this study was to update the life expectancy of patients with hepatocellular carcinoma (HCC) in an exhaustive nationwide population according to the upfront treatment performed.Materials and methods : From the French Program for the Medicalization of Information System database, all patients older than 18 years diagnosed with a de novo HCC from January 2011 to December 2018 were retrospectively selected. Five-year survival rates (95% confidence intervals [CI]) were computed according to the first surgical or interventional radiology procedures performed.Results : A total of 63,996 patients (80% men) with a median age of 68 years (Q 1, Q 3: 61, 77) were selected, including 24,007 patients who underwent at least one procedure (5-year survival of 45.5%; (95% CI: 44.8−46.2), and 39,989 with none (5-year survival, 9.6%; (95% CI: 9.3−10.0). Only 20.5% (13,101/63,996) of patients could undergo an upfront curative procedure. Liver transplantation achieved the best outcome, whether performed upfront (n = 791; 5-year survival, 79.0% [95% CI: 76.1−82.1]) or during subsequent steps (n = 2217; 5-year survival 80.9% [95% CI: 79.2−82.7]). Tumor ablation (n = 5306), open resection (n = 5171), and minimally-invasive resection (n = 1833) achieved 5-year survival rates of 53.8% (95% CI: 52.3−55.4), 54.1% (95% CI: 52.6−55.6), and 66.2% (95% CI: 63.7−68.7), respectively, with more patients with cirrhosis and subsequent procedures in the tumor ablation group. Patients with upfront transarterial (chemo)embolization (n = 10,247) and selective internal radiation therapy (n = 659) had 5-year survival rates of 31.3% (95% CI: 30.3−32.4) and 18.5% (95% CI: 15.2−22.5).Conclusion : While HCC remains mostly diagnosed at an advanced stage associated with a poor prognosis, all the curative options provide 5-year survival rates above 50%.