Tumor stage and primary treatment selection among a large cohort patients with hepatocellular carcinoma.

Abstract

256 Background: This study reviewed the distribution of each tumor stage and each type of primary treatment modality among patients with primary hepatocellular carcinoma (HCC) treated at a tertiary tumor hospital between January 2003 and October 2013. Methods: Baseline data of patients with primary HCC treated between January 2003 and October 2013 were retrospectively collected. Tumor stage was determined according to the Barcelona Clinic Liver Cancer (BCLC) staging system and Hong Kong Clinic Liver Cancer (HKLC) staging system. Results: A total of 6241 patients with primary HCC were included in the analysis. In accordance with the BCLC, 28.9% of patients were in stage 0/A, 16.2% in stage B, 53.6% in stage C, and 1.3% in stage D. According to the HKLC stage system, 8.4% patients were in stage I, 1.5% in stage IIa, 29.0% in stage IIb, 10.0% in stage IIIa, 33.6% in stage IIIb, 3.4% in stage IVa, 2.5% in stage IVb, 0.2% in stage Va, and 11.4% in stage Vb. Treatment modalities applied to this patient group were as follows: 33.3% of patients underwent hepatic resection, 36.7% underwent transarterial chemoembolization (TACE), 2.2% underwent radiotherapy, 0.9% underwent local ablated therapy, 8.8% underwent systemic chemotherapy, 4.2% underwent traditional herbal medicine therapy, 0.1% underwent targeted drug therapy, and 13.8% received no treatment. Hepatic resection was the most frequent therapy for patients with BCLC 0/A/B disease, and TACE was the first-line therapy for patients with BCLC C disease. In the HKLC stage, the main treatments for HKLC I to IIIb disease is hepatic resection and TACE. Systemic chemotherapy was the first-line therapy for patients with HKLC IVa/IVb disease. Most HKLC Va/Vb patients received traditional Chinese medicine (TCM) treatment. Conclusions: Prevalence of stage BCLC B and C disease was high among our HCC patients. In HKLC stage, HKLC I to IIIb disease was high among our HCC patients. Hepatic resection and TACE are first-line therapies.