title: Multimodal treatment of hepatocellular carcinoma: an eastern European experience.
abstract: OBJECTIVE
  The aim of the present study was to evaluate the outcomes of a multimodal treatment approach of hepatocellular carcinoma (HCC) in a tertiary hepatobiliary specialty center.
  
  
  METHODS
  A total of 294 consecutive patients treated for HCC were retrospectively analyzed. Two hundred sixteen patients (73.4%) were men and 78 (26.6%) were women. Liver resection (LR) was performed in 201 patients (68.4%), liver transplantation (LT) in 19 patients (6.5%), radiofrequency ablation (RFA) in 74 patients (25.1%), and 56 (19%) patients received adjuvant systemic chemotherapy.
  
  
  RESULTS
  The median follow-up was 15.7 mo (range 0.1-90.3). Five-year overall survival and recurrence rates were 28% and 26.8%, respectively. Serum AFP > 43.8ng/ml (p = 0.005), BCLC C/D (p = 0.006) and JIS 3/4/5 classifications (p = 0.02) were independent negative prognostic factors for overall survival, while JIS 3/4/5 (p = 0.01) and BCLC C/D (p = 0.01) classifications, tumors larger than 6.5cm (p = 0.001) and RFA (p = 0.02) were independent predictors for recurrence.
  
  
  CONCLUSIONS
  The current treatment of HCC should be multimodal, and therapeutic modalities and their combinations should be tailored to each patient. LT represents the best therapeutic option for patients with HCC in the setting of cirrhosis. Resection remains a good option in cirrhotic patients, while RFA is a safe and effective procedure for small tumors.
authors.affiliation: Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Disease and Liver Transplantation, Bucharest, Romania.
authors.forename: Simona Olimpia
authors.initials: SO
authors.lastname: Dima
authors.forename: Speranţa
authors.initials: S
authors.lastname: Iacob
authors.forename: Florin
authors.initials: F
authors.lastname: Botea
authors.forename: Emil
authors.initials: E
authors.lastname: Matei
authors.forename: Bogdan
authors.initials: B
authors.lastname: Dorobanfu
authors.forename: Serban
authors.initials: S
authors.lastname: Vasile
authors.forename: Sorin
authors.initials: S
authors.lastname: Alexandrescu
authors.forename: Adina
authors.initials: A
authors.lastname: Croitoru
authors.forename: Traian
authors.initials: T
authors.lastname: Dumitrascu
authors.forename: Cezar
authors.initials: C
authors.lastname: Stroescu
authors.forename: Vlad
authors.initials: V
authors.lastname: Herlea
authors.forename: Irinel
authors.initials: I
authors.lastname: Popescu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D002648:Child; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged