PROGNOSIS OF HEPATOCELLULAR-CARCINOMA IN RELATION TO TREATMENT - A MULTIVARIATE-ANALYSIS OF 178 PATIENTS FROM A SINGLE EUROPEAN INSTITUTION

Background. Because the prognosis of patients with hepatocellular carc inoma is not fully understood particularly regarding therapy, we have evaluated it in a series of patients with a homogeneous diagnostic and therapeutic work-up. Methods. From 1985 to 1996, 42 variables were re corded prospectively in 178 consecutive patients who had a diagnosis o f hepatocellular carcinoma. Treatment consisted of liver transplantati on (n = 22), partial hepatectomy (n = 11), arterial chemoembolization (n = 52), systemic or regional chemotherapy (n = 51), and other therap ies (n = 5); 37 patients received no specific therapy. Statistical ana lysts was performed according to a Cox model. Results. There were no d ifferences between the survival of patients receiving chemotherapy, ot her therapies, or no treatment (control group, n = 93). Survival rates at 1, 3, and 5 years were 81%, 74%, and 74% for liver transplantation , 72%, 58%, and 58% for hepatectomy, 55%, 26%, and 13% for chemoemboli zation, and 13%, 3%, and 0% for the control group. Cirrhosis, systemic syndrome, bilobar involvement, Child's stage C disease, and treatment were independent predictors of survival. Conclusions. This series sho ws that certain easily accessible parameters may help establish indivi dual prognosis and stratify patients in clinical trials and indicates that chemoembolization, partial resection, and liver transplantation c an prolong life expectancy of patients with hepatocellular carcinoma.