title: Changing management and outcome of hepatocellular carcinoma: evaluation of 501 patients treated at a single comprehensive center.
abstract: BACKGROUND
  We evaluated changes in therapy and outcome for patients with hepatocellular carcinoma (HCC) over time in a large cohort of Western patients managed at one U.S. medical center.
  
  
  METHODS
  A retrospective analysis of all patients with HCC treated at one U.S. medical center was performed. Analyses were stratified by time intervals 1990-1996 (pre-Milan) and 1997-2004 (post-Milan) to examine impact of UNOS criteria adapted from the post-Milan experience with OLT on treatment and survival.
  
  
  RESULTS
  From 1990 to 2004, 501 patients were identified, 170 (34%) pre-Milan and 331 (66%) post-Milan. Seventy-four (15%) underwent OLT, 99 (20%) had partial hepatectomy (PH), 51 (10%) had ablative therapy (Ablate), 84 (16%) had embolic treatment (Embo), and 194 (39%) had chemotherapy or supportive care (C/SC). Median survival for all patients was 11 months. By time interval, median overall survival (OS) was better for post-Milan patients as compared with the pre-Milan group (13 months vs. 7 months, P = 0.02). On multivariate analysis OLT had the strongest association with improved survival of all factors examined (Odds ratio 12.4, 95% CI 7.7-20.5).
  
  
  CONCLUSIONS
  In this series, treatment post-1996 is associated with improved survival, likely due to improvements in selection criteria and outcomes for liver transplantation.
authors.affiliation: Department of Surgery, Emory University, Atlanta, Georgia 30322, USA. dkooby@emory.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: Vasili
authors.initials: V
authors.lastname: Egnatashvili
authors.forename: Michael
authors.initials: M
authors.lastname: Graiser
authors.forename: Keith A
authors.initials: KA
authors.lastname: Delman
authors.forename: John
authors.initials: J
authors.lastname: Kauh
authors.forename: William C
authors.initials: WC
authors.lastname: Wood
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley Iii
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D017115:Catheter Ablation; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents