Satoshi Kitai1, Masatoshi Kudo1, Naoshi Nishida1, Namiki Izumi2, Michiie Sakamoto3, Yutaka Matsuyama4, Takafumi Ichida5, Osamu Nakashima6, Osamu Matsui7, Yonson Ku8, Norihiro Kokudo9, Masatoshi Makuuchi10. 1. Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan. 2. Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan. 3. Department of Pathology, Keio University School of Medicine, Tokyo, Japan. 4. Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan. 5. Shonan-East General Hospital, Kanagawa, Japan. 6. Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan. 7. Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. 8. hDepartment of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 9. Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 10. Department of Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
Abstract
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) with decompensated liver cirrhosis (LC) is a life-threatening condition, which is amenable to liver transplantation (LT) as the standard first-line treatment. However, the application of LT can be limited due to a shortage of donor livers. This study aimed to clarify the effect of non-surgical therapy on the survival of patients with HCC and decompensated LC. METHODS: Of the 58,886 patients with HCC registered in the nationwide survey of the Liver Cancer Study Group of Japan (January 2000-December 2005), we included 1,344 patients with primary HCC and Child-Pugh (C-P) grade C for analysis in this retrospective study. Among the patients analyzed, 108 underwent LT, 273 were treated by local ablation therapy (LAT), 370 were treated by transarterial chemoembolization (TACE), and 593 received best supportive care (BSC). The effect of LT, LAT, and TACE on overall survival (OS) was analyzed using multivariate and propensity score analyses. RESULTS: Patient characteristics did not differ significantly between each treatment group and the BSC group, after propensity score matching. LAT (hazard ratio [HR]) =0.568; 95% confidence interval [CI], 0.40-0.80) and TACE (HR=0.691; 95% CI, 0.50-0.96) were identified as significant contributors to OS if the C-P score was less than 11 and tumor conditions met the Milan criteria. CONCLUSIONS: For patients with HCC within the Milan criteria and with a C-P score of 10 or 11, locoregional treatment can be used as a salvage treatment if LT is not feasible.
BACKGROUND & AIMS:Hepatocellular carcinoma (HCC) with decompensated liver cirrhosis (LC) is a life-threatening condition, which is amenable to liver transplantation (LT) as the standard first-line treatment. However, the application of LT can be limited due to a shortage of donor livers. This study aimed to clarify the effect of non-surgical therapy on the survival of patients with HCC and decompensated LC. METHODS: Of the 58,886 patients with HCC registered in the nationwide survey of the Liver Cancer Study Group of Japan (January 2000-December 2005), we included 1,344 patients with primary HCC and Child-Pugh (C-P) grade C for analysis in this retrospective study. Among the patients analyzed, 108 underwent LT, 273 were treated by local ablation therapy (LAT), 370 were treated by transarterial chemoembolization (TACE), and 593 received best supportive care (BSC). The effect of LT, LAT, and TACE on overall survival (OS) was analyzed using multivariate and propensity score analyses. RESULTS:Patient characteristics did not differ significantly between each treatment group and the BSC group, after propensity score matching. LAT (hazard ratio [HR]) =0.568; 95% confidence interval [CI], 0.40-0.80) and TACE (HR=0.691; 95% CI, 0.50-0.96) were identified as significant contributors to OS if the C-P score was less than 11 and tumor conditions met the Milan criteria. CONCLUSIONS: For patients with HCC within the Milan criteria and with a C-P score of 10 or 11, locoregional treatment can be used as a salvage treatment if LT is not feasible.
Entities:
Keywords:
Best supportive care; Child-Pugh grade C; Local ablation therapy; Transarterial chemoembolization
Authors: Jae Seung Lee; In Rae Cho; Hye Won Lee; Mi Young Jeon; Tae Seop Lim; Oidov Baatarkhuu; Do Young Kim; Kwang-Hyub Han; Jun Yong Park Journal: Cancer Res Treat Date: 2019-02-12 Impact factor: 4.679