Stuart K Roberts1, Alessia Gazzola1, John Lubel2, Paul Gow3, Sally Bell4, Amanda Nicoll2,5, Anouk Dev6, Michael A Fink7, Siddharth Sood5, Virginia Knight6, Thai Hong4, Eldho Paul8, Gauri Mishra6, Ammar Majeed1, William Kemp1. 1. a Department of Gastroenterology , Alfred Hospital, and Monash University , Melbourne , Australia. 2. b Department of Gastroenterology, Eastern Health and Eastern Health Clinical School , Monash University , Melbourne , Australia. 3. c Department of Gastroenterology , Austin Hospital , Heidelberg , Australia. 4. d Department of Gastroenterology , St Vincent's Hospital , Fitzroy , Australia. 5. g Department of Gastroenterology , Royal Melbourne Hospital , Parkville , Australia. 6. e Department of Gastroenterology , Monash Medical Centre , Clayton , Australia. 7. f Department of Surgery, Austin Hospital , The University of Melbourne , Heidelberg , Australia. 8. h Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine , Monash University , Clinical Haematology Department , Alfred Hospital , Melbourne , Australia.
Abstract
OBJECTIVE: The objectives of our study were firstly to characterize the treatment stage migration phenomenon in early (Barcelona Clinic Liver Cancer [BCLC]-0/A) stage hepatocellular carcinoma (HCC) by comparing the efficacy of curative therapies with trans-arterial chemoembolization [TACE] and secondly, determining baseline and on-treatment predictors of survival. METHODS: All patients within BCLC-0/A stage from six tertiary hospitals who received curative therapy with either resection, transplantation, or ablation or TACE as first-line treatment were included in the analyses. The primary endpoint was overall survival; secondary end-points were transplant-free survival and recurrence-free survival. RESULTS: Between January 2000 and December 2013, we identified 253 BCLC-0/A HCC patients of whom 148 (58.5%) received curative therapy and 105 (41.5%) migrated to TACE. Patients undergoing TACE had lower median survival (2.7 vs. 6.7 years; p < .0001), transplant-free survival (2.6 vs. 4.8 years; p < .0001) and recurrence-free survival (1.3 vs. 2.7 years; p < .001). On multivariate analysis treatment allocation to TACE was an independent prognostic predictor for both lower overall survival (HR 1.70, p = .04) and for HCC recurrence (HR 2.25, p < .001). The main prognostic determinant for each target outcome was Child-Pugh score. CONCLUSIONS: Our study confirms that curative treatments should always be preferred when applicable in early-stage HCC, but that in cases where this is not possible, TACE is a reasonable albeit inferior treatment option. In addition, it provides unique prognostic information on a significant proportion of patients with early-stage disease in whom curative therapy is not applicable.
OBJECTIVE: The objectives of our study were firstly to characterize the treatment stage migration phenomenon in early (Barcelona Clinic Liver Cancer [BCLC]-0/A) stage hepatocellular carcinoma (HCC) by comparing the efficacy of curative therapies with trans-arterial chemoembolization [TACE] and secondly, determining baseline and on-treatment predictors of survival. METHODS: All patients within BCLC-0/A stage from six tertiary hospitals who received curative therapy with either resection, transplantation, or ablation or TACE as first-line treatment were included in the analyses. The primary endpoint was overall survival; secondary end-points were transplant-free survival and recurrence-free survival. RESULTS: Between January 2000 and December 2013, we identified 253 BCLC-0/A HCC patients of whom 148 (58.5%) received curative therapy and 105 (41.5%) migrated to TACE. Patients undergoing TACE had lower median survival (2.7 vs. 6.7 years; p < .0001), transplant-free survival (2.6 vs. 4.8 years; p < .0001) and recurrence-free survival (1.3 vs. 2.7 years; p < .001). On multivariate analysis treatment allocation to TACE was an independent prognostic predictor for both lower overall survival (HR 1.70, p = .04) and for HCC recurrence (HR 2.25, p < .001). The main prognostic determinant for each target outcome was Child-Pugh score. CONCLUSIONS: Our study confirms that curative treatments should always be preferred when applicable in early-stage HCC, but that in cases where this is not possible, TACE is a reasonable albeit inferior treatment option. In addition, it provides unique prognostic information on a significant proportion of patients with early-stage disease in whom curative therapy is not applicable.
Authors: Gauri Mishra; Anouk Dev; Eldho Paul; Wa Cheung; Jim Koukounaras; Ashu Jhamb; Ben Marginson; Beng Ghee Lim; Paul Simkin; Adina Borsaru; James Burnes; Mark Goodwin; Vivek Ramachandra; Manfred Spanger; John Lubel; Paul Gow; Siddharth Sood; Alexander Thompson; Marno Ryan; Amanda Nicoll; Sally Bell; Ammar Majeed; William Kemp; Stuart K Roberts Journal: BMC Cancer Date: 2020-05-29 Impact factor: 4.430
Authors: Kee Fong Loo; Richard J Woodman; Damjana Bogatic; Vidyaleha Chandran; Kate Muller; Mohamed Asif Chinnaratha; John Bate; Kirsty Campbell; Matthew Maddison; Sumudu Narayana; Hien Le; David Pryor; Alan Wigg Journal: JGH Open Date: 2022-07-24