HEPATOCELLULAR-CARCINOMA OUTCOMES BASED ON INDICATED TREATMENT STRATEGY

Hepatocellular carcinoma (HCC) in Western populations historically has been associated with poor survival. In this study, we conducted a 7-y ear retrospective analysis of patients evaluated at our institution wi th HCC to determine the effects of newer treatment strategies on outco me. During the period of study, 117 patients [86 (74%) male; mean age, 59 years (range, 16-85)] were evaluated with treatment as follows: su rgical resection in 22 (19%), chemoembolization with or without system ic chemotherapy in 40 (35%), systemic treatment alone in 16 (13%), ort hotopic liver transplantation in 8 (7%), and supportive care only in 3 1 (26%). Sixty-nine patients (59%) had documented cirrhosis, with hepa titis C being the most common cause in 27 of 69 (39%). In patients rec eiving no treatment, median survival was just under 3 months, with onl y two 1-year survivors. Patients with orthotopic liver transplantation had 1-, 2-, and 3-year survival rates of 87, 87, and 58 per cent comp ared with 69, 52, and 43 per cent in surgically resected patients. Sur vival after chemoembolization was 35, 20, and 11 per cent at 1, 2, and 3 years, whereas survival after systemic chemotherapy was 30 and 15 p er cent at 1 and 2 years, respectively. One-year survival was improved in noncirrhotic patients compared with cirrhotics (47% vs 29%; P < 0. 05) but was no different in patients younger than 55 years compared wi th older patients (38% vs 38%). When possible, surgical treatment stra tegies offer superior survival.