Managing hepatocellular carcinoma in cirrhotic patients in a national hospital in Argentina

Abstract

Background: Liver transplantation and surgery are accepted curative treatments for HCC in cirrhosis, being the first the gold standard but not always available due to scarcity of donors. Materials & Methods: Descriptive analysis of cirrhotic patients with HCC during 2013-2018 in a high-volume center. Patients were stratified by exception points, and blood type. Results in percentages, means, t-test and Chi2 were used. Significance: p<0.05. Kaplan Meyer and log rank test for survival. Results: 179 cirrhotic patients diagnosed with HCC. 131 candidates for liver transplantation. 83 were given additional MELD exception points for HCC and 48 were included on the waiting list with intention to treat and downstaging. There were no differences between age, sex, BMI or Child score. 73 patients were transplanted: 81,9% of the exception points group with a drop out of 16,9% and 10,4% of the intention to treat group (p<0,0001), with a drop out of 66,7% (p<0,0001). Mortality was higher in the second group (58,3%) (p<0,0001). In the first group 43 patients were treated while waiting with TACE (41) and RFA (3), and 37 patients on the second group: TACE (30), RFA (1) and 6 patients were submitted to surgery. The ones resected are alive with a median overall survival of 478,6 days, with one recurrence (16,7%). Analyzing blood type, Blood type 0 has longer waiting time since exception points are given (m=219 days, r 5-369) (p<0,0001) thus most received TACE (76%, p<0,0001). Global 1-year Survival was 76,8%, and 5-year 49,6%, but in the first group 1-year and 5-year survival were 83,3% and 62,6% and 65,7% and 27,2% in second group (p<0,0001). Conclusion: Additional MELD exception points are essential in HCC providing better access to liver transplantation. Drop out is still high and bridge therapies acquire a fundamental role, especially surgery if possible, with excellent long-term Results.