Potentially Curative Treatment in Patients With Hepatocellular Cancer

Results From the Liver Cancer Research Network

F. Kanwal; A. Befeler; R. S. Chari; J. Marrero; J. Kahn; N. Afdhal; T. Morgan; L. Roberts; S. R. Mohanty; J. Schwartz; D. VanThiel; J. Li; A. Zeringue; A. Di'Bisceglie

Disclosures

Aliment Pharmacol Ther. 2012;36(3):257-265. 

In This Article

Abstract and Introduction

Abstract

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.
Aim 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.

Introduction

The incidence of hepatocellular cancer (HCC) has increased by more than two-fold over the past two decades.[1,2] Most of this increase is attributed to hepatitis C virus (HCV) infection acquired 2–3 decades earlier.[1] A large number of HCV-related HCCs are expected in the next decade given that approximately 3.0 million individuals are HCV infected in the United States.[3]

The prognosis of advanced HCC is poor.[4–6] However several potentially curative treatment modalities are available for patients with early stage HCC. These include surgical resection, liver transplantation, and local ablation. Surgical resection is the primary therapeutic option for patients without advanced cirrhosis and with well-preserved liver function and normal portal pressure. Among candidates who receive resection, 5-year survival can exceed 50%.[4,7–11] Liver transplantation is the treatment of choice for HCC patients with decompensated cirrhosis, with 5-year recurrence free survival close to 70%.[12] Potential contraindications to liver transplantation include presence of systemic co-morbidities, and current drug and/or alcohol use. For patients who are not candidates for surgical treatment, local tumour ablation treatments can be used to destroy the tumour without damaging the surrounding liver tissue. These tumour ablation therapies include injection of the tumour with absolute ethanol or radiofrequency ablation. The 5-year survival among patients with compensated cirrhosis and HCC smaller than 5 cm who were treated with local ablation may be as high as 50%.[7,13,14]

There is a paucity of data evaluating the extent, patterns, and outcomes of potentially curative treatment in patients with HCC in the United States. This information is important not only for understanding the diffusion of this practice but also in determining potential effectiveness of HCC surveillance programs—programs that rely heavily on availability and timely application of curative treatments in patients with early HCC.

Using data from a prospective cohort of patients with HCC, we sought to measure the extent to which patients with HCC received potentially curative treatment and investigated whether use of such treatment improved survival. We also determined the factors associated with receipt of potentially curative treatment among patients with HCC.

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