Objective: To compare patient and tumor characteristics and survival between those who declined and accepted cancer directed surgery for hepatocellular carcinoma.

Design: Observational cohort study.

Background: Cancer directed surgery represents the central component of curative approach for hepatocellular carcinoma, but some patients who are eligible surgery may elect not to undergo cancer directed surgery. This study investigated the frequency, cancer directed surgery refusal, characteristics and outcomes among patients with hepatocellular carcinoma.

Patients and Methods: In 31049 patients, age >18 years with hepatocellular carcinoma recorded in the SEER Registry between 1973 and 2004, 13332 patients were recommended for cancer directed surgery, 5378 underwent recommended surgery and 489 refused surgery. Patients who refused surgery were compared with those accepted surgery using logistic regression. The effect of refusal of cancer directed surgery on hepatocellular carcinoma mortality was evaluated by Cox proportional hazards analysis.

Results: 489 patients (3.7% of surgery candidates) declined cancer directed surgery. These patients were more frequently older, non-caucasian, widowed, divorced and those patients who had advanced stage tumors. After accounting for other prognostic factors including patient, tumor characteristics, and those patients who refused surgery had a 2.766-fold (95% confidence interval, 2.339–3.189) increased risk to die of hepatocellular carcinoma compared with operated patients.

Conclusions: The patients who declined cancer directed surgery for hepatocellular carcinoma had an impaired survival. This information might be helpful for those patients who are offered cancer directed surgery to make a better informed decision.

Second AACR International Conference on the Science of Cancer Health Disparities— Feb 3–6, 2009; Carefree, AZ