Treatment options in Western hepatocellular carcinoma: a prospective study of 224 patients

doi:10.1016/S0168-8278(98)80162-1

Journal of Hepatology

Volume 29, Issue 4, October 1998, Pages 650-659

https://doi.org/10.1016/S0168-8278(98)80162-1 Get rights and content

Abstract

Background/Aims: Though hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors in the world, the optimal therapeutic strategy is still poorly defined. This is mainly due to geographic differences in HCC which may affect the validity of treatment regimens in differents areas of the world. The aim of the present study was to analyze the natural course of the disease as well as to assess the efficacy of different therapeutical schemes in HCC observed in Ljubljana (Slovenia) and Trieste (Italy), two cities in Western Europe situated close to each other.

Methods: During the period from January 1988 to December 1993, 224 consecutive patients (132 in Trieste and 92 in Ljubljana) with HCC were enrolled in the study. Patients were treated with the following 3 schemes: surgery 39 (17.4%), transcatheter chemo-embolization (TACE) 116 (51.8%), and no treatment 69 (30.8%). The tumor was classified by Okuda staging and the liver disease by Child-Pugh score. Patients were followed up for 12–60 months, with an average of 40 months. The response rate to TACE and recurrence following surgery were evaluated. Comparative analysis of survival between different treatment groups was performed.

Results: The natural course of the disease, and other characteristics of the HCC, showed a typical Western type of tumor. Liver disease was scored as Child A in 58%, Child B in 30% and Child C in 12%, and the tumor was staged as Okuda I in 52%, Okuda II in 37% and Okuda III in 11%, respectively. Treatment with TACE was followed by an objective response in 27%, with a median survival of 31 months. Surgery was followed by a recurrence rate of 77% within 19.5 months and median survival of 49 months. The overall median survival of nontreated patients was 8 months. Survival in each group of patients differed significantly between all three consecutive stages of Okuda (p<0.001). In contrast, the differences in survival were significant only between Child A and B (p<0.02). The differences between Child B and C were not significant.

Conclusions: This study emphasizes the importance of staging in the choice of treatment modality and diffusion of HCC in affecting an overall response to treatment and survival. Surgery is highly effective in monofocal HCC of Okuda I and II without cirrhosis. TACE is effective in Okuda I and II and Child A cirrhosis only. The treatment of HCC in Child B cirrhosis needs further studies. In Child C and/or Okuda stage II of HCC, any treatment except pure symptomatic relief is detrimental and should not be used.

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Treatment options in Western hepatocellular carcinoma: a prospective study of 224 patients

Abstract

J Hepatol

Am J Surg

Gastroenterology

J Hepatol

J Hepatol

Ann Oncol

Epidemiology of hepatocellular carcinoma

Prevalence of HBsAg carriers among insulin dependent diabetics

Proceedings of the Vth Yugoslav Congress of Infectologist, Portorož

A clinico-pathological analysis of liver cancer with an outline of its development in Slovenia: a study of 30 cases

Exp Clin Gastroenterol

Clinocomorphological manifestations of primary liver carcinoma (PLC) in liver cirrhosis

Cancer Detect Prev

and other members of the Repeat Hepatic Resection Registry. Hepatoma registry of the western world

and the Dionysos Study. Prevalence of chronic liver disease in the general population of Norther Italy: the Dionysos study

Hepatology

Prevalence of hepatocellular carcinoma and relation to cirrhosis: comparison of two different cities of the world: Trieste, Italy and Chiba, Japan

Hepatology

Hepatocellular carcinoma in Italian patients with cirrhosis

N Engl J Med

Natural history of small untreated carcinoma in cirrchosis: a multivariate analysis of prognostic factors of tumor growth rate and patient survival

Hepatology

Transcathether arterial embolization in unresectable hepatocellular carcinoma

Cardiovasc Intervent Radiol

Current treatment modalities for hepatocellular carcinoma

Ann Surg

Effect of repeated transcatheter arterial embolization on the survival time in patients with hepatocellular carcinoma

Cancer