Outcomes of primary hepatocellular carcinoma treatment: an 8-year experience with 368 patients in Thailand.
OBJECTIVE
Primary hepatocellular carcinoma (HCC) is common in Thailand and its prognosis is extremely poor. Hepatic resection and liver transplantation are modes of curative therapy and various therapies have been developed to treat inoperable HCC. This study was performed to determine the outcome of therapy and to identify prognostic factors for survival among Thai patients with HCC.


METHODS
Three hundred and sixty-eight patients with tissue-proven or serodiagnosed HCC were studied. Differences in laboratory investigations, patient survival, treatment outcomes and prognostic factors were analysed. The Kaplan-Meier method and the log-rank test were used to calculate and compare survival of patients receiving different therapies.


RESULTS
Of the 368 patients 317 were males (86.1%, M: F ratio 6.2:1). The median age of all patients was 52 years range (2-85 years). Fifty-nine patients were specifically treated and 209 were conservatively treated. Among those tested, 70% had hepatitis B virus-related HCC. The overall median survival (range) after diagnosis and that of the treated and untreated patients were 5.6 (0-92.1), 9.0 (0-92.1) and 2.3 (0-25.9) months, respectively. More than 50% of the Okuda I patients survived beyond 30 months. The Okuda II and III patients had a median survival (range) of 5.7 (0.1-75.2) and 1.6 (0.1-25.9) months, respectively. Those patients treated by surgery, transcatheter oil chemoembolization and systemic chemotherapy had a better survival rate than did the conservatively managed patients. Surgery was found to be a better treatment than systemic chemotherapy. However, no differences between other pairs of treatment groups were identified. Subgroup analysis of the Okuda II group patients revealed the same results. Independent predictors of death were multiple lesions, advanced Okuda stage and treatment modality.


CONCLUSIONS
Despite various kinds of therapy, the treatment outcomes for Thai HCC patients remain poor and largely depend on the disease extent and treatment received. Most Thai HCC patients are at an advanced stage at diagnosis. Thai patients who received disease-specific treatment other than intraarterial chemotherapy had a better survival rate than did supportive treatment patients.
Pawarode
A
A
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. pawarode@yahoo.com
Tangkijvanich
P
P
Voravud
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome