Outcomes of primary hepatocellular carcinoma treatment: An 8-year experience with 368 patients in Thailand

Background and Aims: Primary hepatocellular carcinoma (HCC) is common in Th ailand and its prognosis is extremely poor. Hepatic resection and liver tra nsplantation are modes of curative therapy and various therapies have been developed to treat inoperable HCC. This study was performed to determine th e outcome of therapy and to identify prognostic factors for survival among Thai patients with HCC. Methods: Three hundred and sixty-eight patients with tissue-proven or serod iagnosed HCC were studied. Differences in laboratory investigations, patien t survival, treatment outcomes and prognostic factors were analysed. The Ka plan-Meier method and the log-rank test were used to calculate and compare survival of patients receiving different therapies. Results: Of the 368 patients 317 were males (86.1%, M:F ratio 6.2:1). The m edian age of all patients was 52 years range (2-85 years). Fifty-nine patie nts were specifically treated and 209 were conservatively treated. Among th ose tested, 70% had hepatitis B virus-related HCC. The overall median survi val (range) after diagnosis and that of the treated and untreated patients were 5.6 (0-92.1), 9.0 (0-92.1) and 2.3 (0-25.9) months, respectively. More than 50% of the Okuda I patients survived beyond 30 months. The Okuda II a nd III patients had a median survival (range) of 5.7 (0.1-75.2) and 1.6 (0. 1-25.9) months, respectively. Those patients treated by surgery, transcathe ter oil chemoembolization and systemic chemotherapy had a better survival r ate than did the conservatively managed patients. Surgery was found to be a better treatment than systemic chemotherapy However, no differences betwee n other pairs of treatment groups were identified. Subgroup analysis of the Okuda II group patients revealed the same results. Independent predictors of death were multiple lesions, advanced Okuda stage and treatment modality . Conclusion: Despite various kinds of therapy, the treatment outcomes for Th ai HCC patients remain poor and largely depend on the disease extent and tr eatment received. Most Thai HCC patients are at an advanced stage at diagno sis. Thai patients who received disease-specific treatment other than intra arterial chemotherapy had a better survival rate than did supportive treatm ent patients. (C) 2000 Blackwell Science Asia Pty Ltd.