Multimodal treatment of hepatocellular carcinoma: an eastern European experience.
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.
Dima
Simona Olimpia
SO
Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute of Digestive Disease and Liver Transplantation, Bucharest, Romania.
Iacob
Speranţa
S
Botea
Florin
F
Matei
Emil
E
Dorobanfu
Bogdan
B
Vasile
Serban
S
Alexandrescu
Sorin
S
Croitoru
Adina
A
Dumitrascu
Traian
T
Stroescu
Cezar
C
Herlea
Vlad
V
Popescu
Irinel
I
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