Analysis of prognostic factors and treatment outcomes for survival in hepatocellular carcinoma patients: Single institute experience

Abstract

Objective: Primary hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and also common in Thailand. Prognosis of HCC is very poor. Staging and clinical prognostic factors is a complex issue compared to other cancer entities. Survival depends on baseline demographic, laboratory, staging and treatment modalities. The aim of the present study was retrospectively identified prognostic factors and treatment modalities that affecting overall survival outcomes. Materials and Methods: Retrospective chart review was performed. Demographic, laboratory and radiologic finding, treatment modalities were collected. Survival outcome was estimated using Kaplan-Meier analysis. The impact of clinical factors and therapy on survival was determined by univariate and multivariate analysis. Results: A total of 99 patients with HCC were included. Median overall survival was 8.9 months. Based on Barcelona Clinical Liver Cancer (BCLC) staging, patients commonly presented at intermediated or late stage, compatible with 2/3 of HCC patients received Transarterial chemoembolization (TACE) therapy when compared with other therapies including best supportive care (BSC) was significantly improved survival (p = 0.02). Patients who had no therapy have a shorter overall survival (3.7 months). Cox-Regression univariate analysis showed younger age (equal or less than 50), abdominal pain, MELD score (more than 10), larger size of tumor (more than 5 cm.), portal vein involvement, resectability, high level of biochemistry and marker such as alkaline phosphatase (ALP), alanine aminotransferase (ALT), alpha-fetoprotein (AFP) and direct bilirubin (DB) and higher BCLC staging (B-D) were identified as clinical predictors of patient survival. Statistical analysis by multivariate showed BCLC staging, age equal or less than 50, DB more than 1 mg/dL and high ALP were significantly shortening survival. Conclusion: The present study identified that BCLC staging could predict survival in patients with HCC whose therapeutic outcomes showed better survival with RFA/PEI and TACE. Despite various therapies, all of the specific treatments had survival benefit comparing to BSC alone. © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2019.