title: Multimodal and sequential treatment improves survival in patients with hepatocellular carcinoma.
abstract: Background and aimsTherapy of hepatocellular carcinoma (HCC) mainly depends on tumor stage and liver function. The aim of this study was to identify additional predictors of overall survival in HCC patients with a particular attention to multimodal therapies.MethodsSix hundred and seven consecutive HCC-patients treated in a tertiary center between 1988 and 2011 were retrospectively analyzed. Multivariate analysis was performed by logistic and Cox-regression, overall survival was analyzed by Kaplan Meier statistics.ResultsIn comparison to unimodal therapies, multimodal treatment increased overall survival in BCLC-A patients from 16 to 26 months (p < 0.001), in patients with BCLC-B stage from 9.5 to 16 months (p < 0.001), in BCLC-C patients from 6 to 18 months (p < 0.001), and in stage BCLC-D from 2 to 8 months (not significant). Survival increased throughout all Child Pugh scores, and patients experienced benefits from multimodal therapy irrespective of alfa-fetoprotein levels. Comparing the time span 1988 - 1999 with 2000 - 2011, the rate of multimodal/sequential treatment increased from 12.3 % to 30 % (p < 0.001), and the overall survival of all (treated and non-treated) patients increased from 7 months (1988 - 1999) to 10 months (2000 - 2011, p < 0.001). In multivariate analysis, multimodal treatment was shown to be an independent predictor for overall survival besides elevated alfa-fetoprotein, Child Pugh score, and BCLC stage.ConclusionMultimodal therapies increase overall survival in HCC patients and should be considered in patients with HCC if practicable.
authors.affiliation: Klinik für Innere Medizin II - Gastroenterologie, Hepatologie und Diabetologie, Petrus-Krankenhaus, Wuppertal, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Göbel
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Graf
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Hosnowsky
authors.affiliation: Klinik für Radiologie, Gefäßradiologie und Nuklearmedizin, Elisabeth-Krankenhaus Rheydt, Mönchengladbach, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Blondin
authors.affiliation: Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
authors.forename: Wolfram Trudo
authors.initials: WT
authors.lastname: Knoefel
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
authors.affiliation: Klinik für Innere Medizin II - Gastroenterologie, Hepatologie und Diabetologie, Petrus-Krankenhaus, Wuppertal, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Erhardt
mesh_terms: D017677:Age Distribution; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods* / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome