Survival after locoregional treatments for hepatocellular carcinoma: a cohort study in real-world patients.
Evidence of relative effectiveness of local treatments for hepatocellular carcinoma (HCC) is scanty. We investigated, in a retrospective cohort study, whether surgical resection, radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), and transarterial embolization with (TACE) or without (TAE) chemotherapy resulted in different survival in clinical practice. All patients first diagnosed with HCC and treated with any locoregional therapy from 1998 to 2002 in twelve Italian hospitals were eligible. Overall survival (OS) was the unique endpoint. Three main comparisons were planned: RFA versus PEI, surgical resection versus RFA/PEI (combined), TACE/TAE versus RFA/PEI (combined). Propensity score method was used to minimize bias related to non random treatment assignment. Overall 425 subjects were analyzed, with 385 (91%) deaths after a median followup of 7.7 years. OS did not significantly differ between RFA and PEI (HR 1.11, 95% CI 0.79-1.57), between surgery and RFA/PEI (HR 0.95, 95% CI 0.64-1.41) and between TACE/TAE and RFA/PEI (HR 0.88, 95% CI 0.66-1.17). 5-year OS probabilities were 0.14 for RFA, 0.18 for PEI, 0.27 for surgery, and 0.15 for TACE/TAE. No locoregional treatment for HCC was found to be more effective than the comparator. Adequately powered randomized clinical trials are still needed to definitely assess relative effectiveness of locoregional HCC treatment.
Department of Medicine and Public Health, Second University of Napoli, Via L Armanni 5, 80138 Napoli, Italy.
Simona
S
Signoriello
Annalisa
A
Annunziata
Nicola
N
Lama
Giuseppe
G
Signoriello
Paolo
P
Chiodini
Ilario
I
De Sio
Bruno
B
Daniele
Giovanni G
GG
Di Costanzo
Fulvio
F
Calise
Graziano
G
Olivieri
Vincenzo
V
Castaldo
Rosario
R
Lanzetta
Guido
G
Piai
Giampiero
G
Marone
Mario
M
Visconti
Mario
M
Fusco
Massimo
M
Di Maio
Francesco
F
Perrone
Ciro
C
Gallo
Giovanni B
GB
Gaeta
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome