Julie N Leal1, Mithat Gonen2, Anne M Covey3, Joseph P Erinjeri3, George Getrajdman3, Constantinos T Sofocleous3, Michael D'Angelica4, Ronald P DeMatteo4, Ghassan K Abou-Alfa5, William R Jarnagin4, Yuman Fong6, Karen T Brown7. 1. Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. 2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. 3. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065; Weill Cornell Medical College, New York, New York. 4. Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065; Weill Cornell Medical College, New York, New York. 5. Department of Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065; Weill Cornell Medical College, New York, New York. 6. Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, City of Hope National Medical Center, Duarte, California. 7. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065; Weill Cornell Medical College, New York, New York. Electronic address: brown6@mskcc.org.
Abstract
PURPOSE: To evaluate the use of locoregional therapy in patients with hepatocellular carcinoma (HCC) with and without extrahepatic disease (EHD). MATERIALS AND METHODS: Patients who underwent locoregional therapy for HCC were identified from institutional databases. Clinicopathologic and treatment characteristics were compared between patients with and without EHD. Survival and progression were assessed using the Kaplan-Meier method, and multivariate analysis was completed. RESULTS: Of 224 patients, 39 (17%) had radiologic evidence of EHD. Patients without EHD were older than patients with EHD (68.8 y ± 10.1 vs 65.0 y ± 11.7, P = .04); underlying liver disease/function and tumor characteristics were not different. Type of locoregional therapy (hepatic artery embolization vs drug-eluting bead transarterial chemoembolization, P = .12; radiofrequency ablation + embolization, P = .07) was similar. Progression occurred in 75% (169/224) of patients. Progression-free survival (PFS) did not differ between the 2 groups (13 [10.3-15.7] mo EHD vs18 [14.6-21.4] mo no EHD, P = .13). Overall survival (OS) was 13 (4.1-21.9) months and 25 (20.4-29.6) months in the EHD and no EHD groups, respectively (P = .02). On multivariate analysis, systemic therapy after locoregional treatment was the only variable independently associated with PFS (hazard ratio [HR] 0.70 [0.49-1.00], P = .04); EHD (HR 1.60 [1.02-2.50], P = .04) and tumor size (HR 1.77 [1.21-2.58], P = .003) were independently associated with worse OS. CONCLUSIONS: Patients with HCC and limited EHD treated with locoregional therapy had worse OS than patients without EHD; PFS was not different. Use of systemic therapy after locoregional therapy was independently associated with improved PFS in this cohort. Further prospective studies of locoregional, systemic, and combination therapies are necessary to improve outcome in these high-risk patients.
PURPOSE: To evaluate the use of locoregional therapy in patients with hepatocellular carcinoma (HCC) with and without extrahepatic disease (EHD). MATERIALS AND METHODS:Patients who underwent locoregional therapy for HCC were identified from institutional databases. Clinicopathologic and treatment characteristics were compared between patients with and without EHD. Survival and progression were assessed using the Kaplan-Meier method, and multivariate analysis was completed. RESULTS: Of 224 patients, 39 (17%) had radiologic evidence of EHD. Patients without EHD were older than patients with EHD (68.8 y ± 10.1 vs 65.0 y ± 11.7, P = .04); underlying liver disease/function and tumor characteristics were not different. Type of locoregional therapy (hepatic artery embolization vs drug-eluting bead transarterial chemoembolization, P = .12; radiofrequency ablation + embolization, P = .07) was similar. Progression occurred in 75% (169/224) of patients. Progression-free survival (PFS) did not differ between the 2 groups (13 [10.3-15.7] mo EHD vs18 [14.6-21.4] mo no EHD, P = .13). Overall survival (OS) was 13 (4.1-21.9) months and 25 (20.4-29.6) months in the EHD and no EHD groups, respectively (P = .02). On multivariate analysis, systemic therapy after locoregional treatment was the only variable independently associated with PFS (hazard ratio [HR] 0.70 [0.49-1.00], P = .04); EHD (HR 1.60 [1.02-2.50], P = .04) and tumor size (HR 1.77 [1.21-2.58], P = .003) were independently associated with worse OS. CONCLUSIONS:Patients with HCC and limited EHD treated with locoregional therapy had worse OS than patients without EHD; PFS was not different. Use of systemic therapy after locoregional therapy was independently associated with improved PFS in this cohort. Further prospective studies of locoregional, systemic, and combination therapies are necessary to improve outcome in these high-risk patients.
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