Change in liver function as measured by change of Child Pugh Score to predict survival in patients with advanced hepatocellular carcinoma (HCC) during the treatment course.

Abstract

310 Background: HCC is the sixth most common cancer and the second leading cause of cancer-related death worldwide. Most HCCs develop in severely damaged liver. Methods: The effect of multiple treatment options on liver function (LF) and disease outcome of patients (pts) with HCC (n = 380) were examined retrospectively. Pt LF (Child Pugh score [CPS]) was assessed at time of diagnosis (dx) and then after treatment. Kaplan Meier with log rank and Chi square test was used for comparisons. Results: Our cohort of 380 pts had the following demographics: 74% were male and 26% female; 42% were African American, 26% Caucasian, 13% Asian, and 8% undetermined. The mean age at dx was 62.7 yrs; 17% and 61% of pts were between 40-55 and 56-70 yrs, respectively. Only 2% were below 40 yrs, and 19.6% were above 70 yrs of age. About half of pts smoked (55%) or drank (54%). Regarding viral infection, 17% had Hep B, 52% Hep C, 3% both, and 26% neither. Risky behavior correlated with age of dx: pts aged 56-70 yrs of age had the highest of both (p < 0.05). Cirrhosis and vascular invasion were seen in 66% and 40% of pts, respectively. Stage I/II HCC was seen in 38% and stage III/IV in 68% of pts. Median OS was significantly higher for stage I/II pts (p < 0.001). Pts who had no change or improvement in LF had longer median OS vs. pts who had declining LF (p < 0.001). Considering all treatment scenarios including local and systemic therapy, LF improved in 13%, did not change in 41%, and worsened in 46% of pts. LF decline in pts receiving various treatments was as follows: 53%, sorafenib (SFB); 39%, TACE; 53% radiation; 58% TACE/Y-90/SFB; and 32%, immunotherapy independent of prior treatment. However the degree in LF decline, as dictated by a ΔCPS of > 4, 3 to 4, or 1 to 2 points, did not by itself correlate with significant changes in median OS. Conclusions: The outcome of pts with HCC depends on disease stage and LF. Most pts experience LF decline during treatment. The degree of LF decline is independent of median OS, but maintaining LF is significantly beneficial for OS. Balancing survival benefit with liver toxicities is critical to the successful treatment of pts with advanced HCC.