Presentation and outcomes of hepatocellular carcinoma patients at a western centre

Abstract

Background: The present study examines the presentation and outcomes of hepatocellular carcinoma (HCC) at a Western centre over the last decade.

Methods: Between January 2000 and September 2009, 1010 patients with HCC were evaluated at the University of Pittsburgh Medical Center (UPMC). Retrospectively, four treatment groups were classified: no treatment (NT), systemic therapy (ST), hepatic artery-based therapy (HAT) and surgical intervention (SI) including radiofrequency ablation, hepatic resection and transplantation. Kaplan-Meier analysis assessed survival between groups. Cox regression analysis identified factors predicting survival.

Results: Patients evaluated were 75% male, 87% Caucasian, 84% cirrhotic, and predominantly diagnosed with hepatitis C. In all, 169 patients (16.5%) received NT, 25 (2.4%) received ST, 529 (51.6%) received HAT and 302 (29.5%) received SI. Median survival was 3.6, 5.6, 8.8, and 83.5 months with NT, ST, HAT and SI, respectively (P= 0.001). Transplantation increased from 9.5% to 14.2% after the model for end-stage liver disease (MELD) criteria granted HCC patients priority points. Survival was unaffected by bridging transplantation with HAT or SI (P= 0.111). On multivariate analysis, treatment modality was a robust predictor of survival after adjusting for age, gender, AFP, Child-Pugh classification and cirrhosis (P < 0.001, χ(2) = 460).

Discussion: Most patients were not surgical candidates and received HAT alone. Surgical intervention, especially transplantation, yields the best survival.

Figure 1

Breakdown of treatment modalities for hepatocellular carcinoma patients. NT, no treatment; ST, systemic therapy; HAT, hepatic artery-based therapy; SI, surgical intervention; RFA, radiofrequency ablation

Figure 2

Survival by treatment modality. NT, no treatment; ST, systemic therapy; HAT, hepatic artery-based therapy; SI, surgical intervention

Figure 3

Survival by surgical intervention. RFA, radiofrequency ablation

Figure 4

Survival by bridging therapy to transplant. HAT bridging to transplant included TACE and Y90. SI bridging to transplant included radiofrequency ablation and liver resection. HAT, hepatic artery-based therapy; SI, surgical intervention

Figure 5

Survival by Child–Pugh classification

Figure 6

Survival by alpha-fetoprotein (AFP) level (400 ng/mL cutoff)