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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Survival characteristics of fibrolamellar hepatocellular carcinoma: A Surveillance, Epidemiology, and End Results database study
Tomoki Sempokuya, Arnold Forlemu, Muaataz Azawi, Krixie Silangcruz, Nathalie Khoury, Jihyun Ma, Linda L Wong
Tomoki Sempokuya, Arnold Forlemu, Nathalie Khoury, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
Muaataz Azawi, Division of Gastroenterology and Hepatology, Sanford Center for Digestive Health, Sioux Falls, SD 57105, United States
Krixie Silangcruz, Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States
Jihyun Ma, Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States
Linda L Wong, Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States
Author contributions: Sempokuya T contributed to study design, data collection, statistical analysis; Sempokuya T, Forlemu A, Silangcruz K, Azawi M, Khoury N contributed to the literature review, manuscript drafting, and editing; Ma J contributed to study design and statistical analysis; Wong LL contributed to study supervision, manuscript drafting, and editing; all of the authors have approved the final version of the manuscript.
Institutional review board statement: Due to the utilization of a publicly available, de-identified database, review by our institutional review board was not required.
Informed consent statement: Informed consent was not required to conduct this study.
Conflict-of-interest statement: Wong LL is a speaker bureau for Eisai. All other authors do not have any conflicts of interest.
Data sharing statement: All of the data used in this analysis is available from the SEER database.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Tomoki Sempokuya, MD, Doctor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198, United States. tsempoku@hawaii.edu
Received: December 25, 2021
Peer-review started: December 25, 2021
First decision: March 16, 2022
Revised: March 29, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 24, 2022
ARTICLE HIGHLIGHTS
Research background
Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare and distinct type of hepatocellular carcinoma.
Research motivation
Due to its rare nature, there is a limited understanding of factors affecting the survival outcomes.
Research objectives
This study aims to characterize the survival of FL-HCC by age, race, and surgical intervention.
Research methods
FL-HCC patients were retrospectively identified with The Surveillance, Epidemiology, and End Results database. We conducted three separate survival analyses by age groups; ≤ 19, 20-59, and ≥ 60-year-old, and race; White, Black, Asian and Pacific Islanders (API), and Hispanic and surgical types; Wedge resection or segmental resection, lobectomy, extended lobectomy (lobectomy + locoregional therapy or resection of the other lobe), and transplant.
Research results
We identified 225 FL-HCC patients. Overall median survival was 34 (95%CI: 27-41) mo. Patients ≤ 19-year-old had more advanced disease with positive lymph nodes status. However, they received more surgical interventions. Survival months for ≤ 19 was 85 (95%CI: 37-137), 20-59 was 29 (95%CI: 18-41), and ≥ 60 was 12 (95%CI: 7-31) mo (P < 0.001). APIs lived in the area with a higher median household income, and Blacks lived in the area with a lower median household income. There were no differences in stages, lymph node status, metastasis status, and surgical treatment. Whites had 39 (95%CI: 29-63), Blacks 26 (95%CI: 5-92), Hispanics 31 (95%CI: 11-54), and APIs 28 (95%CI: 5-39) mo (P = 0.28). Of 225 patients, 111 FL-HCC patients had surgical procedures. Median survivals for a wedge or segmental resection was 112 (95%CI: 78-NA), lobectomy was 92 (95%CI: 57-NA), extended lobectomy was 54 (95%CI: 23-NA), and a transplant was 63 (95%CI: 20-NA) mo (P < 0.001). The median survival was better in patients who had surgical treatments regardless of lymph nodes or metastasis status (P < 0.001).
Research conclusions
This study demonstrated a better survival of younger patients with FL-HCC, although they had aggressive diseases. There were no racial differences in survival for FL-HCC, which is seen in HCC. Surgical treatment provided better survival regardless of advanced disease.
Research perspectives
This study can help healthcare professionals to guide FL-HCC patients about the outcome, especially after the surgical intervention. Further prospective studies are needed to elucidate in the era of personalized cancer therapy.
