title: Outcome of patients with hepatocellular carcinoma referred to a tertiary centre with availability of multiple treatment options including cadaveric liver transplantation.
abstract: Hepatocellular carcinoma (HCC) is a primary cancer of the liver with an established causal link to viral hepatitis and other forms of chronic liver disease.
  
  
  OBJECTIVE
  The aim of this study was to analyse the determinants of outcome in patients with HCC referred to a tertiary centre for management.
  
  
  METHODS
  Two hundred and thirty-five prospective patients with HCC and minimum 12-month follow-up were studied.
  
  
  RESULTS
  The cohort was heterogeneous, with 52% Caucasian, 40% Asian and 5% of Middle-Eastern origin. Independent predictors of outcome included tumour size and number, the presence of ascites or portal vein thrombosis, alpha-foetoprotein >50 U/L and an impaired performance status. Treatment was determined on an individual case basis by a multidisciplinary tumour team. Surgical resection was primary treatment in 43 patients, liver transplantation in 40 patients, local ablation (percutaneous radiofrequency ablation or alcohol injection) in 33 patients, transarterial chemoembolisation in 33 patients, chemotherapy or other systemic therapy in 30 patients and no treatment in 56 patients. After adjustment for significant covariates, both liver transplantation (P<0.001) and surgical resection (P=0.029) had a significant effect on patient survival compared with no treatment, but local ablation (P=0.410) and chemoembolisation (P=0.831) did not. Liver transplantation resulted in superior overall and, in particular, disease-free survival compared with surgical resection (disease-free survival 84 vs 15% at 5 years).
  
  
  CONCLUSIONS
  In conclusion, both surgical resection and liver transplantation significantly improve the survival of patients with HCC, but improvements need to be made to the delivery of loco-regional therapy to enhance its effectiveness.
authors.affiliation: AW Morrow Gastroenterology and Liver Centre, Australian National Liver Transplant Unit, NHMRC Centre for Clinical Research Excellence to Improve Outcomes in Liver Disease, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Perry
authors.forename: Barbara
authors.initials: B
authors.lastname: Charlton
authors.forename: David J
authors.initials: DJ
authors.lastname: Koorey
authors.forename: Richard C
authors.initials: RC
authors.lastname: Waugh
authors.forename: P James
authors.initials: PJ
authors.lastname: Gallagher
authors.forename: Michael D
authors.initials: MD
authors.lastname: Crawford
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Verran
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: McCaughan
authors.forename: Simone I
authors.initials: SI
authors.lastname: Strasser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation; D015996:Survival Rate; D016896:Treatment Outcome