Presentation and outcomes of hepatocellular carcinoma patients at a western centre. HPB (Oxford) 2011 Oct;13(10):712-22
Date
09/21/2011Pubmed ID
21929672Pubmed Central ID
PMC3210973DOI
10.1111/j.1477-2574.2011.00362.xScopus ID
2-s2.0-80053564459 (requires institutional sign-in at Scopus site) 28 CitationsAbstract
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.
Author List
Kitisin K, Packiam V, Steel J, Humar A, Gamblin TC, Geller DA, Marsh JW, Tsung AAuthor
Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAntineoplastic Agents
Carcinoma, Hepatocellular
Catheter Ablation
Chemoembolization, Therapeutic
Chi-Square Distribution
Female
Hepatectomy
Humans
Kaplan-Meier Estimate
Liver Neoplasms
Liver Transplantation
Male
Middle Aged
Patient Selection
Pennsylvania
Proportional Hazards Models
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Survival Rate
Time Factors
Treatment Outcome
