title: Survival Benefit of Locoregional Treatment for Hepatocellular Carcinoma with Advanced Liver Cirrhosis.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) with decompensated liver cirrhosis (LC) is a life-threatening condition, which is amenable to liver transplantation (LT) as the standard first-line treatment. However, the application of LT can be limited due to a shortage of donor livers. This study aimed to clarify the effect of non-surgical therapy on the survival of patients with HCC and decompensated LC.
  
  
  METHODS
  Of the 58,886 patients with HCC registered in the nationwide survey of the Liver Cancer Study Group of Japan (January 2000-December 2005), we included 1,344 patients with primary HCC and Child-Pugh (C-P) grade C for analysis in this retrospective study. Among the patients analyzed, 108 underwent LT, 273 were treated by local ablation therapy (LAT), 370 were treated by transarterial chemoembolization (TACE), and 593 received best supportive care (BSC). The effect of LT, LAT, and TACE on overall survival (OS) was analyzed using multivariate and propensity score analyses.
  
  
  RESULTS
  Patient characteristics did not differ significantly between each treatment group and the BSC group, after propensity score matching. LAT (hazard ratio [HR]) =0.568; 95% confidence interval [CI], 0.40-0.80) and TACE (HR=0.691; 95% CI, 0.50-0.96) were identified as significant contributors to OS if the C-P score was less than 11 and tumor conditions met the Milan criteria.
  
  
  CONCLUSIONS
  For patients with HCC within the Milan criteria and with a C-P score of 10 or 11, locoregional treatment can be used as a salvage treatment if LT is not feasible.
authors: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan.
authors: Satoshi
authors: S
authors: Kitai
authors: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan.
authors: Masatoshi
authors: M
authors: Kudo
authors: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan.
authors: Naoshi
authors: N
authors: Nishida
authors: Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
authors: Namiki
authors: N
authors: Izumi
authors: Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
authors: Michiie
authors: M
authors: Sakamoto
authors: Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan.
authors: Yutaka
authors: Y
authors: Matsuyama
authors: Shonan-East General Hospital, Kanagawa, Japan.
authors: Takafumi
authors: T
authors: Ichida
authors: Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan.
authors: Osamu
authors: O
authors: Nakashima
authors: Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
authors: Osamu
authors: O
authors: Matsui
authors: hDepartment of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Yonson
authors: Y
authors: Ku
authors: Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors: Norihiro
authors: N
authors: Kokudo
authors: Department of Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
authors: Masatoshi
authors: M
authors: Makuuchi
keywords: Best supportive care; Child-Pugh grade C; Local ablation therapy; Transarterial chemoembolization