title: The effectiveness of locoregional therapies versus supportive care in maintaining survival within the Milan criteria in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  To compare survival after treatment with either locoregional therapy (LRT) or supportive care in patients with hepatocellular carcinoma (HCC) within the Milan criteria.
  
  
  METHODS
  Patients with HCC who were classified within the Milan criteria (solitary HCC <or= 5 cm or <or= 3 tumors with none greater than 3 cm in largest diameter, and no macrovascular invasion) and underwent transcatheter therapy or radiofrequency ablation (RF ablation) between 1998 and 2008 were retrospectively studied. Patients with tumor burden within the Milan criteria who received the best supportive care only were used as the control group. Survival within the Milan criteria was compared between those who underwent LRT and patients who underwent supportive care.
  
  
  RESULTS
  Of 162 patients studied, 110 patients (67.9%) underwent LRT, and 52 patients (32.1%) received supportive care alone. Median survival within the Milan criteria for patients who did and did not receive LRT were 644 days (95% confidence interval [CI], 193-1094) and 162 days (95% CI, 73-250) respectively (P < .001). In patients who received LRT, Child Pugh class was prognostic for survival within the Milan criteria on multivariate analysis (P = .002, hazard ratio 5.16 [2.69-9.89]). The long-term survival for patients who did not undergo transplant was 502 days (95% CI, 91-912) in patients who received LRT and 151 days (95% CI, 59-242) in patients who were treated with supportive care (P < .001).
  
  
  CONCLUSIONS
  LRT is more effective than supportive care in prolonging survival within the Milan criteria in patients with HCC. The long-term survival in patients not undergoing transplant was significantly longer for patients who received LRT than for patients who were treated with supportive care.
authors.affiliation: Division of Interventional Radiology and Image-guided Medicine, Department of Radiology, Emory University School of Medicine, 1364 Clifton Road NE, Suite AG-05, Atlanta, GA 30322, USA.
authors.forename: Renumathy
authors.initials: R
authors.lastname: Dhanasekaran
authors.forename: Vinit
authors.initials: V
authors.lastname: Khanna
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: James R
authors.initials: JR
authors.lastname: Spivey
authors.forename: Samir
authors.initials: S
authors.lastname: Parekh
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Knechtle
authors.forename: John D
authors.initials: JD
authors.lastname: Carew
authors.forename: John S
authors.initials: JS
authors.lastname: Kauh
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005845:Georgia; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome