Potentially curative treatment in patients with hepatocellular cancer--results from the liver cancer research network.
BACKGROUND
The extent to which potentially curative therapies are used in patients with hepatocellular cancer (HCC) and their related outcomes are unknown in the US.


OBJECTIVE
To determine the rate and outcomes of potentially curative treatment in patients with HCC.


METHODS
Eleven US centers followed patients with HCC between 2001 and 2007. We determined rates of liver transplantation, surgical resection, or tumour ablation during follow-up, examined differences in adjusted survival of patients receiving these treatments, and determined the factors associated with receipt of potentially curative treatment.


RESULTS
Of the 267 patients, 76 (28%) patients had early HCC, defined as Child A or B cirrhosis, with a solitary HCC or ≤ 3 nodules, each ≤ 3 cm. Of these, 53 (69.7%) received curative treatment. Thirty six percent of patients with non-early HCC received curative treatment. Compared to patients with non-early HCC who did not receive curative treatment, patients with early HCC and curative treatment had the best survival [hazard ratio, HR = 0.19 (95% CI, 0.08-0.42)] followed by patients with advanced HCC who received curative treatment [HR = 0.37 (95% CI, 0.22-0.64)]. Baseline performance status was significantly associated with receipt of curative treatment as well as survival after adjusting for demographics, clinical characteristics, and HCC stage.


CONCLUSIONS
In this multicenter database, most of the patients with early HCC received potentially curative treatment. However, only 28% of patients had early HCC. One-third of patients with non-early HCC also underwent curative therapy. Potentially curative treatment improved survival and this effect was seen in patients with early as well as non-early HCC.
John Cochran VA Medical Center, Saint Louis, MO, USA. fasiha.kanwal@va.gov
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F
Kanwal
A
A
Befeler
R S
RS
Chari
J
J
Marrero
J
J
Kahn
N
N
Afdhal
T
T
Morgan
L
L
Roberts
S R
SR
Mohanty
J
J
Schwartz
D
D
VanThiel
J
J
Li
A
A
Zeringue
A
A
Di'Bisceglie
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States