Relief of symptoms and quality of life after conservative versus surgical treatment of benign liver tumors (CONSULT): a retrospective propensity score matched study.

BACKGROUND: Surgery can be considered for selected patients with benign liver tumours (BLT). The aim of this study was to compare symptoms and quality of life (QoL) after conservative and surgical management of BLT. METHODS: In this dual-site cross-sectional retrospective study, adult patients with BLT diagnosed between 2000 and 2019 completed EORTC QLQ-C30 questionnaires on current symptoms and symptoms at diagnosis. Summary scores (SumScores) and QoL scores at follow-up were compared between surgically and conservatively treated patients by matched t-tests. Propensity score matching attempted to reduce confounding. Higher scores indicate less symptoms and higher QoL. RESULTS: Fifty surgically (22.6%) and 171 (77.4%) conservatively treated patients were included at median 95 (IQR:66-120) and 91 (IQR:52-129) months, respectively. Most surgically treated patients reported stable, improved or disappeared symptoms (87%) and would undergo surgery again (94%). After propensity score matching, surgical patients had higher SumScores (mean difference 9.2, 95%CI:1.0-17.4, p = 0.028) but not higher QoL scores (p = 0.331) at follow-up than conservatively treated counterparts (31 patients in both groups). DISCUSSION: Patients who had undergone surgery often reported they would undergo surgery again. Moreover, they had less symptoms than conservatively managed patients while they were propensity score matched on relevant variables, including baseline symptoms.

Trends in incidence, diagnosis, treatment and survival of hepatocellular carcinoma in a low-incidence country: Data from the Netherlands in the period 2009-2016.

OBJECTIVE: Evaluation of the trends in incidence, diagnostics, treatment and survival of patients with hepatocellular carcinoma (HCC) in the Netherlands. METHOD: Data regarding incidence, diagnostics, primary treatment and survival of patients with HCC in the period 2009-2016 were obtained from the Netherlands Cancer Registry. Trends in incidence, diagnostics, various treatment modalities (except liver transplantation, due to inaccurate data) and regional treatment preferences were analysed. Survival was evaluated using Kaplan-Meier curves and multivariable Cox proportional hazard regression modelling. RESULTS: In the period of 2009-2016, 3838 patients were diagnosed with HCC. A distinct decrease in the percentage of patients who underwent tumour biopsy was observed (from 51% in 2009-2010 to 42% in 2015-2016). Percentage of patients who underwent cancer treatment increased markedly (from 49% in 2009-2010 to 57% in 2015-2016), mainly because of an increasing use of resection and ablation. The number of hospitals where resections were performed or sorafenib treatment prescribed decreased slightly. The number of hospitals sporadically (<1 ablation per year) performing ablations increased. There were significant differences between regions in the application of resection, ablation and transarterial chemoembolisation /radioembolisation (p < 0.05 after 'case mix'-correction). One-, 3- and 5-year survival of patients with HCC significantly improved in the studied period. Receiving cancer treatment was associated with increased survival, whereas increasing age and an advanced tumour stage were both associated with decreased survival. CONCLUSION: From 2009 to 2016, patients with hepatocellular carcinoma more often received cancer treatment and their survival improved. There were significant differences in types of treatment between various regions.