Current state and clinical outcome in Turkish patients with hepatocellular carcinoma

Abstract

Aim: To investigate clinical, etiological, and prognostic features in patients with hepatocellular carcinoma. Methods: Patients with hepatocellular carcinoma who were followed-up from 2001 to 2011 were included in the study. The diagnosis was established by histopathological and/or radiological criteria. We retrospectively reviewed clinical and laboratory data, etiology of primary liver disease, imaging characteristics and treatments. Child-Pugh and Barcelona Clinic Liver Cancer stage was determined at initial diagnosis. Kaplan-Meier survival analysis was done to find out treatment effect on survival. Risk factors for vascular invasion and overall survival were investigated by multivariate Cox regression analyses. Results: Five hundred and forty-five patients with hepatocellular carcinoma were included in the study. Viral hepatitis was prevalent and 68 patients either had normal liver or were non-cirrhotic. Overall median survival was 16 (13-19) mo. Presence of extrahepatic metastasis was associated with larger tumor size (OR = 3.19, 95% CI: 1.14-10.6). Independent predictor variables of vascular invasion were AFP (OR = 2.95, 95% CI: 1.38-6.31), total tumor diameter (OR = 3.14, 95% CI: 1.01-9.77), and hepatitis B infection (OR = 5.37, 95% CI: 1.23-23.39). Liver functional reserve, tumor size/extension, AFP level and primary treatment modality were independent predictors of overall survival. Transarterial chemoembolization (HR = 0.38, 95% CI: 0.28-0.51) and radioembolization (HR = 0.36, 95% CI: 0.18-0.74) provided a comparable survival benefit in the real life setting. Surgical treatments as resection and transplantation were found to be associated with the best survival compared with loco-regional treatments (log-rank, P < 0.001). Conclusion: Baseline liver function, oncologic features including AFP level and primary treatment modality determines overall survival in patients with hepatocellular carcinoma.