Hepatocellular carcinoma in the United States: Prognostic features, treatment outcome, and survival

Abstract

BACKGROUND. The purpose of this study was to investigate prognostic factors at presentation and the survival of North American patients with hepatocellular carcinoma (HCC). METHODS. A retrospective analysis of medical records was performed for 314 patients identified through the Tumor Registry as having been evaluated for hepatocellular carcinoma at the Deaconess Hospital, Boston, Massachusetts, from 1986 through 1995. Clinical characteristics were noted, including age, sex, TNM staging, serum biochemistries, serum alpha-fetoprotein (AFP), patency of portal vasculature, cirrhosis, history of alcohol abuse, hepatitis-B or C positivity, hemochromatosis, treatment received, and ultimate survival from the date of diagnosis. RESULTS. Overall median survival was 10 months. The presence of cirrhosis, a history of alcohol abuse, low albumin, high bilirubin, abnormal AFP, and portal vein obstruction (PVO) were each associated with significantly shorter survival, as was advanced stage. Only albumin, AFP, and PVO were independent risk factors by multiple regression analysis. Patients undergoing surgery had the longest median survival (45 months), followed by those receiving chemoembolization (14 months). Those patients who were untreated or received systemic chemotherapy alone had significantly shorter survivals (2-4 months). CONCLUSIONS. Despite the difference in the underlying etiology of HCC in this population compared with Asian patients, poor prognostic indicators are similar. In this large series of patients at a single Northeastern hospital, analysis of presenting clinical characteristics was found to offer useful prognostic information.

Survival rate in patients with hepatocellular carcinoma: a retrospective analysis of 389 patients

“…Therefore, this data reflects the current situation, for unselected patients with HCC similar to a different study published 9 years ago (Stuart et al, 1996). As previously reported for other non-Asian centres (Stuart et al, 1996;Rabe et al, 2001;Erhardt et al, 2002), our patient population differed significantly from Asian centres (Sithinamsuwan et 2000) with less HbsAg-positive patients in our study population. Moreover, the average age of our patients was 64 years old indicating that currently HCC is more frequently diagnosed in older patients as described by others (Dohmen et al, 2004).…”

“…As expected these patients had lower survival rates. However, with minor differences depending on the group of patients selected and treatment modalities chosen, similar results were reported by others (Stuart et al, 1996;Allgaier et al, 1998;Bruix and Llovet, 2002;Herold et al, 2002;O'Suilleabhain et al, 2003).…”

“…No patient was excluded from our retrospective analysis in contrast to those studies, who investigated only the effect of surgery or local ablative therapy (Tanaka et al, 1998;Schlitt et al, 1999;O'Suilleabhain et al, 2003;Jaeck et al, 2004). Therefore, this data reflects the current situation, for unselected patients with HCC similar to a different study published 9 years ago (Stuart et al, 1996). As previously reported for other non-Asian centres (Stuart et al, 1996;Rabe et al, 2001;Erhardt et al, 2002), our patient population differed significantly from Asian centres (Sithinamsuwan et 2000) with less HbsAg-positive patients in our study population.…”

“…In Asia, HBV infection is the major risk factor for HCC, whereas HCV infection and alcohol use are more frequently the cause for liver cirrhosis and HCC in the Western world (Wang et al, 2002). Additionally, the application of treatment options and the success with which they are applied varies as well, so that it is essential to study not only responses to therapy and overall survival in patients but also the prognostic risk factors (Stuart et al, 1996). Until today there is only limited data available describing the outcome related to baseline patient characteristics among all patients with HCC in Western countries.…”

What is the best staging system for hepatocellular carcinoma in the setting of liver transplantation?

“…Few of these systems include an assessment of the presence of cancerrelated symptoms. 4,8,9,17,18 The assessment of the Eastern Cooperative Oncology Group performance status 19 or the Karnofsky index 20 is a well-established item in oncology practices; patients with a performance status > 2 are usually considered to have a grim prognosis, and the survival impact of any therapy is highly doubtful. Among the recently assessed systems that are used today, only the BCLC and GRETCH systems assess the performance status, and the CUPI system assesses the presence or absence of symptomatic disease.…”