BACKGROUND: The present study examines the presentation and outcomes of hepatocellular carcinoma (HCC) at a Western centre over the last decade. METHODS: Between January 2000 and September 2009, 1010 patients with HCC were evaluated at the University of Pittsburgh Medical Center (UPMC). Retrospectively, four treatment groups were classified: no treatment (NT), systemic therapy (ST), hepatic artery-based therapy (HAT) and surgical intervention (SI) including radiofrequency ablation, hepatic resection and transplantation. Kaplan-Meier analysis assessed survival between groups. Cox regression analysis identified factors predicting survival. RESULTS: Patients evaluated were 75% male, 87% Caucasian, 84% cirrhotic, and predominantly diagnosed with hepatitis C. In all, 169 patients (16.5%) received NT, 25 (2.4%) received ST, 529 (51.6%) received HAT and 302 (29.5%) received SI. Median survival was 3.6, 5.6, 8.8, and 83.5 months with NT, ST, HAT and SI, respectively (P= 0.001). Transplantation increased from 9.5% to 14.2% after the model for end-stage liver disease (MELD) criteria granted HCC patients priority points. Survival was unaffected by bridging transplantation with HAT or SI (P= 0.111). On multivariate analysis, treatment modality was a robust predictor of survival after adjusting for age, gender, AFP, Child-Pugh classification and cirrhosis (P < 0.001, χ(2) = 460). DISCUSSION: Most patients were not surgical candidates and received HAT alone. Surgical intervention, especially transplantation, yields the best survival.
BACKGROUND: The present study examines the presentation and outcomes of hepatocellular carcinoma (HCC) at a Western centre over the last decade. METHODS: Between January 2000 and September 2009, 1010 patients with HCC were evaluated at the University of Pittsburgh Medical Center (UPMC). Retrospectively, four treatment groups were classified: no treatment (NT), systemic therapy (ST), hepatic artery-based therapy (HAT) and surgical intervention (SI) including radiofrequency ablation, hepatic resection and transplantation. Kaplan-Meier analysis assessed survival between groups. Cox regression analysis identified factors predicting survival. RESULTS:Patients evaluated were 75% male, 87% Caucasian, 84% cirrhotic, and predominantly diagnosed with hepatitis C. In all, 169 patients (16.5%) received NT, 25 (2.4%) received ST, 529 (51.6%) received HAT and 302 (29.5%) received SI. Median survival was 3.6, 5.6, 8.8, and 83.5 months with NT, ST, HAT and SI, respectively (P= 0.001). Transplantation increased from 9.5% to 14.2% after the model for end-stage liver disease (MELD) criteria granted HCC patients priority points. Survival was unaffected by bridging transplantation with HAT or SI (P= 0.111). On multivariate analysis, treatment modality was a robust predictor of survival after adjusting for age, gender, AFP, Child-Pugh classification and cirrhosis (P < 0.001, χ(2) = 460). DISCUSSION: Most patients were not surgical candidates and received HAT alone. Surgical intervention, especially transplantation, yields the best survival.
Authors: S Jonas; M Herrmann; N Rayes; T Berg; C Radke; S Tullius; U Settmacher; T Steinmüller; P Neuhaus Journal: Transplant Proc Date: 2001 Nov-Dec Impact factor: 1.066
Authors: Riad Salem; Robert J Lewandowski; Laura Kulik; Edward Wang; Ahsun Riaz; Robert K Ryu; Kent T Sato; Ramona Gupta; Paul Nikolaidis; Frank H Miller; Vahid Yaghmai; Saad M Ibrahim; Seanthan Senthilnathan; Talia Baker; Vanessa L Gates; Bassel Atassi; Steven Newman; Khairuddin Memon; Richard Chen; Robert L Vogelzang; Albert A Nemcek; Scott A Resnick; Howard B Chrisman; James Carr; Reed A Omary; Michael Abecassis; Al B Benson; Mary F Mulcahy Journal: Gastroenterology Date: 2010-10-30 Impact factor: 22.682
Authors: Donald Poon; Benjamin O Anderson; Li-Tzong Chen; Koichi Tanaka; Wan Yee Lau; Eric Van Cutsem; Harjit Singh; Wan Cheng Chow; London Lucien Ooi; Pierce Chow; Maung Win Khin; Wen Hsin Koo Journal: Lancet Oncol Date: 2009-11 Impact factor: 41.316
Authors: H Tsukuma; T Hiyama; S Tanaka; M Nakao; T Yabuuchi; T Kitamura; K Nakanishi; I Fujimoto; A Inoue; H Yamazaki Journal: N Engl J Med Date: 1993-06-24 Impact factor: 91.245
Authors: T Livraghi; A Giorgio; G Marin; A Salmi; I de Sio; L Bolondi; M Pompili; F Brunello; S Lazzaroni; G Torzilli Journal: Radiology Date: 1995-10 Impact factor: 11.105
Authors: Alexis P Chidi; Cindy L Bryce; Larissa Myaskovsky; Michael J Fine; David A Geller; Douglas P Landsittel; Allan Tsung Journal: Ann Surg Date: 2016-02 Impact factor: 12.969
Authors: Ryan T Groeschl; Ray K Wong; Edward J Quebbeman; Susan Tsai; Kiran K Turaga; Sam G Pappas; Kathleen K Christians; Eric J Hohenwalter; Sean M Tutton; William S Rilling; T Clark Gamblin Journal: HPB (Oxford) Date: 2012-10-11 Impact factor: 3.647