title: Multimodal approach and its impact on survival for patients with hepatocellular carcinoma.
abstract: BACKGROUND
  There are few studies evaluating the prognostic impact on survival of treatment strategy in patients with hepatocellular carcinoma (HCC). The aim of this study was to analyse whether a multimodal approach, that represents a synergic association of different therapeutic procedures, may improve survival of patients with HCC.
  
  
  METHODS
  Two hundred and fourteen patients with HCC were enrolled in the study. The multimodal approach was chosen for 27 out of 106 (25%) non surgical patients, 42 out of 81 (52%) patients who underwent liver resection and 19 out of 27 (70%) patients who underwent liver transplantation.
  
  
  RESULTS
  The long-term survival of patients who underwent the multimodal approach improved significantly with respect to patients treated by both resection and other therapies alone. The 5-year survival rates were 52% vs. 11% (p < 0.05) in the non surgical group and 40% vs. 24% (p < 0.05) in the resection group when a multimodal approach was used for the treatment of recurrences. In patients with advanced HCC undergoing liver transplantation, multimodal treatment resulted in long-term survival comparable to that of patients with early HCC.
  
  
  CONCLUSIONS
  A multimodal approach should be suggested in all patients with HCC, since a careful integration of surgical and non surgical treatments may improve long-term survival in such patients.
authors.affiliation: Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, 35128 Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bassanello
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vitale
authors.forename: Franco
authors.initials: F
authors.lastname: Lumachi
authors.forename: Francesco A
authors.initials: FA
authors.lastname: Ciarleglio
authors.forename: Patrizia
authors.initials: P
authors.lastname: Boccagni
authors.forename: Alberto
authors.initials: A
authors.lastname: Brolese
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zanus
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Amico
authors.forename: Marco
authors.initials: M
authors.lastname: Senzolo
authors.forename: Davide Francesco
authors.initials: DF
authors.lastname: D'Amico
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome