The effectiveness of locoregional therapies versus supportive care in maintaining survival within the Milan criteria in patients with hepatocellular carcinoma

Abstract

Purpose: To compare survival after treatment with either locoregional therapy (LRT) or supportive care in patients with hepatocellular carcinoma (HCC) within the Milan criteria.

Materials and methods: Patients with HCC who were classified within the Milan criteria (solitary HCC <or= 5 cm or <or= 3 tumors with none greater than 3 cm in largest diameter, and no macrovascular invasion) and underwent transcatheter therapy or radiofrequency ablation (RF ablation) between 1998 and 2008 were retrospectively studied. Patients with tumor burden within the Milan criteria who received the best supportive care only were used as the control group. Survival within the Milan criteria was compared between those who underwent LRT and patients who underwent supportive care.

Results: Of 162 patients studied, 110 patients (67.9%) underwent LRT, and 52 patients (32.1%) received supportive care alone. Median survival within the Milan criteria for patients who did and did not receive LRT were 644 days (95% confidence interval [CI], 193-1094) and 162 days (95% CI, 73-250) respectively (P < .001). In patients who received LRT, Child Pugh class was prognostic for survival within the Milan criteria on multivariate analysis (P = .002, hazard ratio 5.16 [2.69-9.89]). The long-term survival for patients who did not undergo transplant was 502 days (95% CI, 91-912) in patients who received LRT and 151 days (95% CI, 59-242) in patients who were treated with supportive care (P < .001).

Conclusions: LRT is more effective than supportive care in prolonging survival within the Milan criteria in patients with HCC. The long-term survival in patients not undergoing transplant was significantly longer for patients who received LRT than for patients who were treated with supportive care.