Retrospective evaluation of tumor-mass-reduction therapy for the prognosis of recurrent hepatocellular carcinoma

Abstract

Although hepatocellular carcinoma (HCC) is the liver cancer that requires repeated treatments because of a high tendency for recurrence, few data have been available about whether repeated treatments, including those to reduce tumor mass, are effective in prolonging survival. We retrospectively analyzed the effectiveness of tumor-mass-reduction therapy for the prognosis of patients with recurrent HCC. To analyze the effectiveness of various modalities of therapies with a single criterion, we defined a tumor-mass-reduction grade (TMRG), which was retrospectively evaluated by dynamic CT or MRI. Grade A: no evident HCC remains untreated; Grade B1: more than 50% of lesions are treated; and Grade B2: less than 50% of lesions are treated. Subjects were stratified by Child-Pugh classification and the number of admissions for HCC treatment. In those classified as Child-Pugh A, a better survival rate was obtained, depending on the degree of TMRG from the first to the fifth admission (P < .01), suggesting that these patients are endurable for repeated therapies and benefit from the many sessions of treatment. In those classified as Child-Pugh B, on the second to the fifth admissions, survival rates showed statistical difference depending on the TMRG (P < .01), which may suggest that only a few sessions of treatment are meaningful. In those classified as Child-Pugh C, any number of mass-reduction treatment sessions did not improve the survival rate. In conclusion, repeated tumor-mass-reduction therapies for recurrent HCC are most beneficial in Child-Pugh A patients. Patients with Child-Pugh B who experience several recurrence episodes and any patients with Child-Pugh C may benefit more from modalities other than tumor-mass-reduction therapies.