Hepatocellular carcinoma in the United States. Prognostic features, treatment outcome, and survival.
BACKGROUND
The purpose of this study was to investigate prognostic factors at presentation and the survival of North American patients with hepatocellular carcinoma (HCC).


METHODS
A retrospective analysis of medical records was performed for 314 patients identified through the Tumor Registry as having been evaluated for hepatocellular carcinoma at the Deaconess Hospital, Boston, Massachusetts, from 1986 through 1995. Clinical characteristics were noted, including age, sex, TNM staging, serum biochemistries, serum alpha-fetoprotein (AFP), patency of portal vasculature, cirrhosis, history of alcohol abuse, hepatitis-B or C positivity, hemochromatosis, treatment received, and ultimate survival from the date of diagnosis.


RESULTS
Overall median survival was 10 months. The presence of cirrhosis, a history of alcohol abuse, low albumin, high bilirubin, abnormal AFP, and portal vein obstruction (PVO) were each associated with significantly shorter survival, as was advanced stage. Only albumin, AFP, and PVO were independent risk factors by multiple regression analysis. Patients undergoing surgery had the longest median survival (45 months), followed by those receiving chemoembolization (14 months). Those patients who were untreated or received systemic chemotherapy alone had significantly shorter survivals (2-4 months).


CONCLUSIONS
Despite the difference in the underlying etiology of HCC in this population compared with Asian patients, poor prognostic indicators are similar. In this large series of patients at a single Northeastern hospital, analysis of presenting clinical characteristics was found to offer useful prognostic information.
Stuart
K E
KE
Boston Center for Liver Cancer, Deaconess Hospital, Boston, Massachusetts, USA.
Anand
A J
AJ
Jenkins
R L
RL
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D014408:Biomarkers, Tumor / Q000097:blood; D001900:Boston / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006432:Hemochromatosis / Q000453:epidemiology; D006525:Hepatitis, Viral, Human / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000032:analysis; D009367:Neoplasm Staging; D011169:Portal Vein; D011379:Prognosis; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D016019:Survival Analysis; D015996:Survival Rate; D013927:Thrombosis / Q000453:epidemiology; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D012709:Serum Albumin; D000509:alpha-Fetoproteins