Hepatocellular Carcinoma (HCC)

Abstract

Purpose: Surgical approaches remain the only curative option for HCC. The two main procedures available are resection and liver transplantation. The purpose of this study was to analyze the outcome of 36 patients treated surgically with curative intent at the UIC. Methods: Information about all patients with HCC treated at UIC since 1998 was retrospectively collected by electronic chart review. Statistical Analysis was performed utilizing the SAS Biostatistical software. Results: A Total of 194 patients were identified. The distribution of the stages was: 18 (9.2%) were Stage I, 65(33.5%) stage II, 44(22.7%) stage III, 60(30.9%) stage IV and 7(3.6%) had unclear stage. Of these, 36 (18.6%) underwent surgical therapies with curative intent. Eleven (5.7% of the total), underwent resection and 25 (12.9%), transplant. Using the Wilcoxon statistical test, the median survival time for these patients was 37 months with 95% confidence interval (CI 95%) 30–42 months. In patients treated with non surgical therapies the median survival was 12 months (CI 95% 8–17 months) p < 0.0001. The median survival for patients undergoing transplant was 38 months (CI 95% 31–58) and it was 26 months (CI 95% 1–37) for the resection group. The median time to recurrence for all surgically treated patients was 33 months (CI 95% 22–37 months). There was no significant difference in the recurrence time between transplant and resection groups. Recurrence was treated with a second surgical procedure, ethanol ablation, chemoembolization or systemic chemotherapy. Even though the percentage of patients potentially eligible for surgery (stages I and II combined) was 44.1%, less than half of these received either one. The inferior median survival of the patients treated with palliative modalities is probably explained at least in part by a more advanced median stage as well as other comorbidities that precluded surgery. Survival seemed better in patients treated with transplant than in those treated with resection; however these results should be taken with caution because of the wide confidence interval. Conclusions: HCC continues to carry a very poor prognosis. Patients who are able to undergo surgical resection or transplant have the longest survival but most patients are not eligible for these interventions.