Factors related to survival in hepatocellular carcinoma in the geographic area of Sabadell (Catalonia, Spain)

Abstract

BAckground: hepatocellular carcinoma (HCC) is a very frequent tumor. Screening for the disease is effective, but the prognostic factors are difficult to evaluate.Objectives: 1. To determine epidemiological data and the clinical course of HCC in our setting. 2. To compare patient survival according to whether screening is performed or not. 3. To evaluate survival prognostic factors.Patients and methods: data on the epidemiology and clinical course of patients diagnosed with HCC were collected on a prospective basis (January 2004-December 2006. Two groups were considered according to whether screening had been performed (group A) or not (group B).Results: a total of 110 patients were diagnosed with HCC (70% males). The most common etiology of cirrhosis was hepatitis C (56.1%), and 69% presented mild liver failure (Child-Pugh grade A). The median follow-up was 1.8 years. Fifty-one percent had been subjected to screening. The diagnosis of HCC was established by imaging techniques in 48.2% of the cases, and by histological criteria in 51.8%. The median tumor size was 23 mm in group A and 28 mm in group B (p = 0.005). Treatment with curative intent was provided in 72% of the cases in group A and in 48% in group B (p = 0.011). The median overall survival was 1.99 years -2.67 years in group A and 1.75 years in group B (p = 0.05).The multivariate analysis of overall survival showed the type of treatment (OR = 2.82 95%CI: 1.3-6.12, p = 0.009) and liver function (OR = 1.71 95%CI: 1.1-2.68, p = 0.020) to be independent predictors of survival.Conclusions: screening allows the diagnosis of smaller lesions and a higher percentage of curative treatments. The degree of liver function and the provision of curative treatment are independent predictors of survival.

Early Detection, Curative Treatment, and Survival Rates for Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis: A Meta-analysis

“…Rates of early tumor detection were consistent across study location (OR 2.22 [95% CI 1.75–2.81] among studies conducted in Asia [17],[34],[38],[49] versus 2.00 [95% CI 1.70–2.35] among studies in Europe [37],[42],[55],[57],[63] versus 2.31 [95% CI 1.79–2.99] among studies in the United States [32],[33],[35],[41],[43],[44],[45],[47],[52],[53],[61]), study period (OR 2.22 [95% CI 1.77–2.79] among studies assessing surveillance in the 1990s [17],[29],[49],[53],[55] versus 2.18 [95% CI 1.86–2.56] among studies assessing surveillance after 2000 [18],[32]–[35],[37],[38],[41]–[43],[45],[47],[52],[57],[61],[63]), and type of surveillance tests (OR 2.04 [95% CI 1.55–2.68] with ultrasound alone [18],[32],[38],[47],[61] versus 2.16 [95% CI 1.80–2.60] with ultrasound and/or AFP [17],[29],[34],[35],[37],[42]–[45],[49],[52],[53],[55],[63]). There was no significant difference in the association between HCC surveillance and early stage tumor detection by study design ( p  = 0.10), with patients detected by surveillance being more likely to be found at an early stage in both subgroups.…”

“…Among the 16 cohort studies that reported both early detection (using Milan or BCLC criteria) and curative treatment rates [17],[29],[32]–[35],[37],[38],[43],[44],[47],[49],[53],[55],[61],[63], we found a moderately strong positive correlation between early detection rates and curative treatment rates between studies (Pearson's correlation r = 0.54) (Figure S4). This finding suggests the association between surveillance and receipt of curative treatment is mediated by improved early tumor detection rates.…”

“…Twenty-four studies defined early stage using BCLC or Milan criteria [17],[18],[24],[29],[32]–[35],[37],[38],[41]–[45],[47]–[49],[52],[53],[55],[57],[61],[63], whereas six studies used other staging systems (e.g., tumor node metastases [TNM]) [23],[31],[39],[46],[54],[59], and eight used operational definitions (e.g., unifocal lesion less than 3 cm) [20],[21],[25],[26],[28],[36],[40],[50] (Table 1). The 24 studies using BCLC or Milan criteria included a total of 6,573 patients, of whom 2,815 (44.1%) were diagnosed by surveillance.…”

“…When only including studies using BCLC or Milan criteria, there was little change in effect size (OR 2.08, 95% CI 1.80–2.37) or heterogeneity (I 2  = 77%, p <0.001). On subset analysis of the six studies using BCLC to define early stage, the pooled odds ratio was also stable at 1.96 (95% CI 1.41–2.73) [18],[24],[32],[34],[37],[42]. One notable outlier was a study by Cho and colleagues, which had a relative risk of 37.81 (95% CI 5.27–271.13) [24].…”

“…There was no significant difference in the association between HCC surveillance and early stage tumor detection by study design ( p  = 0.10), with patients detected by surveillance being more likely to be found at an early stage in both subgroups. The pooled odds ratio was 2.30 (95% CI 1.98–2.67) among retrospective studies [17],[18],[29],[32]–[35],[38],[41],[43],[44],[47],[49],[52],[53],[61],[63], compared to 1.70 (95% CI 1.29–2.26) among studies in which data were prospectively collected [37],[42],[45],[55],[57]. Heterogeneity in early tumor detection may be related to several factors including variations in ultrasound operator experience and technique, patient body habitus, and liver nodularity, which we were unable to explore given the lack of patient-level data.…”