Published online Jan 27, 2018. doi: 10.4254/wjh.v10.i1.51
Peer-review started: August 23, 2017
First decision: December 4, 2017
Revised: December 7, 2017
Accepted: December 29, 2017
Article in press: December 29, 2017
Published online: January 27, 2018
To investigate clinical, etiological, and prognostic features in patients with hepatocellular carcinoma.
Patients with hepatocellular carcinoma who were followed-up from 2001 to 2011 were included in the study. The diagnosis was established by histopathological and/or radiological criteria. We retrospectively reviewed clinical and laboratory data, etiology of primary liver disease, imaging characteristics and treatments. Child-Pugh and Barcelona Clinic Liver Cancer stage was determined at initial diagnosis. Kaplan-Meier survival analysis was done to find out treatment effect on survival. Risk factors for vascular invasion and overall survival were investigated by multivariate Cox regression analyses.
Five hundred and forty-five patients with hepatocellular carcinoma were included in the study. Viral hepatitis was prevalent and 68 patients either had normal liver or were non-cirrhotic. Overall median survival was 16 (13-19) mo. Presence of extrahepatic metastasis was associated with larger tumor size (OR = 3.19, 95%CI: 1.14-10.6). Independent predictor variables of vascular invasion were AFP (OR = 2.95, 95%CI: 1.38-6.31), total tumor diameter (OR = 3.14, 95%CI: 1.01-9.77), and hepatitis B infection (OR = 5.37, 95%CI: 1.23-23.39). Liver functional reserve, tumor size/extension, AFP level and primary treatment modality were independent predictors of overall survival. Transarterial chemoembolization (HR = 0.38, 95%CI: 0.28-0.51) and radioembolization (HR = 0.36, 95%CI: 0.18-0.74) provided a comparable survival benefit in the real life setting. Surgical treatments as resection and transplantation were found to be associated with the best survival compared with loco-regional treatments (log-rank, P < 0.001).
Baseline liver function, oncologic features including AFP level and primary treatment modality determines overall survival in patients with hepatocellular carcinoma.
Core tip: Hepatocellular carcinoma is a leading cause of cancer-related death with curative treatment options limited to orthotopic liver transplantation, surgical resection and local ablation. Our study confirmed that liver functional reserve, tumor extension and alfa-fetoprotein level are among the most important determinants of patient survival. Survival benefit of non-curative treatments including transarterial chemoembolization and Yttrium-90 radioembolization remains an area of uncertainty. In this study we showed that transarterial chemoembolization and Yttrium-90 radioembolization provided a significant and comparable survival benefit in patients with hepatocellular carcinoma in the real-life setting. We concluded that primary modality of treatment for hepatocellular carcinoma is a major determinant of patient survival that should be incorporated while estimating prognosis.