Survival rates according to the Cancer of the Liver Italian Program scores of 345 hepatocellular carcinoma patients after multimodality treatments during a 10-year period in a retrospective study.
OBJECTIVE
The Cancer of the Liver Italian Program (CLIP) score has been demonstrated to have superior prognostic ability in hepatocellular carcinoma (HCC) patients worldwide, but there has never been sufficient assessment of the efficacy of treatment modalities according to the CLIP score. This retrospective cohort study of HCC patients was conducted to assess the efficacy of treatment modalities according to the CLIP score.


METHODS
We compared the efficacy of hepatic resection (HR) (n = 101), radiofrequency ablation with prior transcatheter arterial chemoembolization (RFA + TACE) (n = 115), percutaneous ethanol injection with prior TACE (PEI + TACE) (n = 43), and TACE (n = 86) as a primary treatment in terms of survival among 345 patients treated at Mie University Hospital between 1995 and 2004, according to CLIP score.


RESULTS
The overall survival rates in the RFA + TACE group were significantly higher in the patients with CLIP scores of 1, 2, and 3 or more (5-year, 70.9%; 3-year, 73.7%; and 3-year, 100%, respectively), but they were not significantly different from the 5-year survival rates of the HR group with a CLIP score of 0 (83.7%). Among the patients with a CLIP score of 0, a significantly higher disease-free survival rate (5-year: 33.7%) was obtained in the HR subgroup (n = 35) than in the RFA + TACE subgroup (n = 35), both of which were followed since 2000, but morbidity (21.8%) was highest in the HR group.


CONCLUSIONS
RFA + TACE is concluded to be a safe treatment modality with better overall survival (5-year, > 60%) in HCC patients regardless of their CLIP score.
Yamagiwa
Kentaro
K
Department of Surgery, Mie Prefectural Shima Hospital, Mie, Japan. yamagiwa@shimahp.pref.mie.jp
Shiraki
Katsuya
K
Yamakado
Koichiro
K
Mizuno
Shugo
S
Hori
Tomohide
T
Yagi
Shinichiro
S
Hamada
Takashi
T
Iida
Taku
T
Nakamura
Ikuo
I
Fujii
Koji
K
Usui
Masanobu
M
Isaji
Shuji
S
Ito
Keiichi
K
Tagawa
Shinsei
S
Takeda
Kan
K
Yokoi
Hajime
H
Noguchi
Takashi
T
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007267:Injections; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D009367:Neoplasm Staging; D018579:Patient Selection; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D000431:Ethanol