Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Improves Outcome
ABSTRACT Liver transplantation has become an effective treatment for cirrhotic patients with early-stage hepatocellular carcinoma. We hypothesized that the quality of surveillance for hepatocellular carcinoma influences prognosis by affecting access to liver transplantation.
A total of 269 patients with cirrhosis and hepatocellular carcinoma were retrospectively categorized into 3 groups according to quality of surveillance: standard-of-care (n=172) (group 1); substandard surveillance (n=48) (group 2); and absence of surveillance in patients not recognized to be cirrhotic (n=59) (group 3).
Three-year survival in the 60 patients who underwent liver transplantation was 81% versus 12% for patients who did not undergo transplantation (P<.001). The percentages of patients who underwent transplantation according to tumor stage at diagnosis (T1, T2, T3, and T4) were 58%, 35%, 10%, and 1%, respectively. Hepatocellular carcinoma was diagnosed at stages 1 and 2 in 70% of patients in group 1, 37% of patients in group 2, and only 18% of patients in group 3 (P <.001). Liver transplantation was performed in 32% of patients in group 1, 13% of patients in group 2, and 7% of patients in group 3 (P<.001). Three-year survival from cancer diagnosis in patients in group 3 (12%) was significantly worse than in patients in group 1 (39%) or group 2 (27%) (each P<.05). Eighty percent of patients in group 3 had subtle abnormalities of cirrhosis on routine laboratory tests.
The quality of surveillance has a direct impact on hepatocellular carcinoma stage at diagnosis, access to liver transplantation, and survival.
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ABSTRACT: Purpose: To assess the use of curative therapies for hepatocellular carcinomas (HCC) in the population.Methods: HCC treatment patterns were examined in SEER 18 registries (28% of U.S.). Joinpoint regression analyses were performed to assess 2000-2010 incidence trends by tumor size, count and receipt of potentially curative treatments (transplantation, resection and ablation). SEER-Medicare data enabled evaluation of treatment patterns including receipt of sorafenib or TACE by HCC-associated co-morbidities.Results: Diagnoses of tumors ≤5.0 cm in diameter significantly increased during 2000- 2010, surpassing diagnosis of larger tumors. Overall, 23% of cases received potentially curative treatment. Joinpoint models indicated incidence rates of treatment with curative intent increased 17.6% per year during 2000-2005, then declined by -2.9% per year during 2005-2010 (P< 0.001). Among HCC cases with a single tumor ≤5.0 cm and no extension beyond the liver, use of ablative therapy significantly increased during 2000-2010. Use of invasive surgery for single tumors, regardless of size, significantly increased during the initial years of the decade then plateaued. The group most likely to receive curative treatment in the SEER-Medicare cases was patients with one, small tumor confined to the liver (657 of 1597 cases, 41%), with no difference in treatment by hepatic co-morbidity status (P=0.24). A higher proportion of cases with reported liver-associated co-morbidities were, however diagnosed with tumors ≤5.0 cm in diameter (1745 0f 2464, 71%) compared to patients with no reported co-morbidities (996 of 2596, 38%, P<0.001).Conclusion: Although more HCC patients were diagnosed with early disease over time, the use of curative treatments in this patient group has recently plateaued. Efforts to identify and treat more eligible candidates for curative therapy could be beneficial. (Hepatology 2014;)Hepatology 11/2014; 60(5). DOI:10.1002/hep.27288 · 11.19 Impact Factor
Clinical Gastroenterology and Hepatology 07/2014; DOI:10.1016/j.cgh.2014.07.033 · 6.53 Impact Factor
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ABSTRACT: The prognosis of untreated patients with hepatocellular carcinoma (HCC) is heterogeneous, and survival data were mainly obtained from control arms of randomised studies. Clinical practice data on this topic are urgently needed, so as to help plan studies and counsel patients. We assessed the prognosis of 600 untreated patients with HCC managed by the Italian Liver Cancer Group. Prognosis was evaluated subdividing patients according to the Barcelona Clinic Liver Cancer (BCLC) classification. We also assessed the main demographic, clinical, and oncological determinants of survival in the subgroup of patients with advanced HCC (BCLC C). Advanced (BCLC C, n=138, 23.0%) and end-stage HCC (BCLC D, n=210, 35.0%) represented the majority of patients. Overall median survival was 9 months, and the principal cause of death was tumour progression (n=279, 46.5%). Patients median survival progressively and significantly decreased as BCLC stage worsened (BCLC 0, 38 months; BCLC A, 25 months, BCLC B, 10 months; BCLC C, 7 months, BCLC D, 6 months; P<0.0001). Female gender [Hazard Ratio (HR)=0.55, 95% confidence interval (95%CI)=0.33-0.90, P=0.018], ascites (HR=1.81, 95%CI=1.21-2.71, P=0.004), and multinodular (>3) HCC (HR=1.79, 95%CI=1.21-2.63, P=0.003) were independent predictors of survival in patients with advanced HCC (BCLC C). Conclusions: The BCLC adequately predicts the prognosis of untreated HCC patients. In untreated patients with advanced HCC, female gender, clinical decompensation of cirrhosis and multinodular tumour are independent prognostic predictors and should be taken into account for patients stratification in future therapeutic studies. (Hepatology 2014;)Hepatology 01/2015; 61(1). DOI:10.1002/hep.27443 · 11.19 Impact Factor