Expanded use of aggressive therapies improves survival in early and intermediate hepatocellular carcinoma

Abstract

Background: Despite the increasing annual incidence of hepatocellular carcinoma (HCC) in the USA, now estimated at 2.7 cases per 100 000 population, only a small proportion of patients receive treatment and 5-year survival rates range from 9% to 17%.

Objectives: The present study examines the effects of multimodal treatment on survival in a mixed-stage HCC cohort, focusing on the impact of radical therapy in patients with Barcelona Clinic Liver Cancer (BCLC) stage B disease.

Methods: A retrospective review of the medical records of 254 patients considered for HCC treatment between 2003 and 2011 at a large tertiary referral centre was conducted.

Results: A total of 195 (76.8%) patients were treated with a median of two liver-directed interventions. Median survival time was 16 months. In proportional hazards analysis, radiofrequency ablation (RFA) and resection were associated with significantly improved 1- and 5-year survival among patients with BCLC stage 0-A disease. In patients with BCLC stage B disease, RFA conferred a survival benefit at 1 year and resection was associated with significantly improved survival at 5 years.

Conclusions: As one of few studies to track the complete course of sequential HCC therapies, the findings of the present study suggest that HCC patients with intermediate-stage (BCLC stage B) disease may benefit from aggressive interventions not currently included in societal guidelines.

Figure 1

Probability of remaining alive at (a) 1 year and (b) 5 years by most efficacious treatment modality received in hepatocellular carcinoma patients with Barcelona Clinic Liver Cancer (BCLC) stage B disease. (a) Kaplan–Meier curves indicate that the use of aggressive therapy confers a statistically significant survival benefit compared with the use of locoregional therapies (LRTs) at 1 year among patients with BCLC stage B disease. (b) Patients who underwent hepatic resection achieved a statistically significant increase in the probability of remaining alive at 5 years compared with those undergoing LRTs