DOI QR코드

DOI QR Code

Aggressive Treatment of Performance Status 1 and 2 HCC Patients Significantly Improves Survival - an Egyptian Retrospective Cohort Study of 524 Cases

  • Aziz, Ashraf Omar Abdel (Department of Endemic Medicine and Hepatogastroenterology, National Cancer Institute, Cairo University) ;
  • Omran, Dalia (Department of Endemic Medicine and Hepatogastroenterology, National Cancer Institute, Cairo University) ;
  • Nabeel, Mohamed Mahmoud (Department of Endemic Medicine and Hepatogastroenterology, National Cancer Institute, Cairo University) ;
  • Elbaz, Tamer Mahmoud (Department of Endemic Medicine and Hepatogastroenterology, National Cancer Institute, Cairo University) ;
  • Abdelmaksoud, Ahmed Hosni (Department of Diagnostic and Interventional Radiology, Faculty of Medicine, National Cancer Institute, Cairo University) ;
  • Attar, Inas El (Department of Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo University) ;
  • Shousha, Hend Ibrahim (Department of Endemic Medicine and Hepatogastroenterology, National Cancer Institute, Cairo University)
  • Published : 2016.05.01

Abstract

Background: In the Barcelona Clinic Liver Cancer (BCLC) system, only sorafenib is suggested for HCC patients having performance status (PS) 1 or 2 even if they have treatable lesions. In the current study, we aimed to explore the outcome of using aggressive treatment for HCC patients with PS 1 and 2. Materials and Methods: Five hundred and twenty four patients with HCC were enrolled in this study and divided into 2 groups: 404 PS 1 and 120 PS 2. Of the included 524 patients, 136 recceived non-aggressive supportive treatment and sorafenib, while 388 patients were offered aggressive treatment in the form of surgical resection, transplantation, percutaneous ablation, trans-arterial chemoembolization and/or chemoperfusion. All the patients were followed up for a period of 2 years to determine their survival. Results: Most HCC patients were CHILD A and B grades (89.4% versus 85.0%, for PS1 and PS2, respectively). Patients with PS1 were significantly younger. Out of the enrolled 524 patients, 388 were offered aggressive treatment, 253 (65.2%) having their lesions fully ablated, 94 (24.2%) undergoing partial ablation and 41 patients with no ablation (10.6%). The median survival of the patients with PS 1 who were offered aggressive treatment was 20 months versus 9 months only for those who were offered supportive treatment and sorafenib (p<0.001). Regarding HCC patients with PS 2, the median survivals were similarly 19.7 months versus 8.7 months only (p<0.001). Conclusions: Aggressive treatment of HCC patients with PS 1 and 2 significantly improves their survival. Revising the BCLC guidelines regarding such patients is recommended.

Keywords

HCC;performance status;aggressive treatment;outcome;prognosis

References

  1. Bruix J, Sherman M (2011). Management of hepatocellular carcinoma: an update. Hepatol, 53, 1020-2. https://doi.org/10.1002/hep.24199
  2. Cabibbo G, Genco C, Di Marco V, et al (2011). Predicting survival in patients with hepatocellular carcinoma treated by transarterialchemoembolisation. Aliment Pharmacol Ther, 34, 196-204 https://doi.org/10.1111/j.1365-2036.2011.04694.x
  3. European Association For The Study Of The LiverEuropean Organization For Research And Treatment Of Cancer (2012). EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol, 56, 908-43. https://doi.org/10.1016/j.jhep.2011.12.001
  4. Gomaa AI, Hashim MS, Waked I (2014). Comparing staging systems for predicting prognosis and survival in patients with hepatocellular carcinoma in Egypt. PLoS One, 9, 90929. https://doi.org/10.1371/journal.pone.0090929
  5. Greten TF, Wang XW, Korangy F (2015). Current concepts of immune based treatments for patients with HCC: from basic science to novel treatment approaches. Gut, 64, 842-8 https://doi.org/10.1136/gutjnl-2014-307990
  6. Hsu CY, Lee YH, Hsia CY, et al (2013). Performance status in patients with hepatocellular carcinoma: determinants, prognostic impact, and ability to improve the Barcelona Clinic Liver Cancer system. Hepatol, 57,112-9. https://doi.org/10.1002/hep.25950
  7. Hsu CY, Liu PH, Lee YH, et al (2015). Aggressive therapeutic strategies improve the survival of hepatocellular carcinoma patients with performance status 1 or 2: a propensity score analysis. Ann Surg Oncol, 22, 1324-31.
  8. Kim BK, Kim SU, Park JY, et al (2012). Applicability of BCLC stage for prognostic stratification in comparison with other staging systems: single-centre experience from long-term clinical outcomes of 1717 treatment-naive patients with hepatocellular carcinoma. Liver Int, 32, 1120-7. https://doi.org/10.1111/j.1478-3231.2012.02811.x
  9. Kudo M, Osaki Y, Matsunaga T, et al (2013). Hepatocellular carcinoma in Child-Pugh C cirrhosis: prognostic factors and survival benefit of nontransplant treatments. Dig Dis, 31, 490-8. https://doi.org/10.1159/000355259
  10. Lee YH, Hsia CY, Hsu CY, et al (2013). Total tumor volume is a better marker of tumor burden in hepatocellular carcinoma defined by the Milan criteria. World J Surg, 37, 1348-55. https://doi.org/10.1007/s00268-013-1978-9
  11. Lee YH, Hsu CY, Huo TI (2013). Assessing liver dysfunction in cirrhosis: role of the model for end-stage liver disease and its derived systems. J Chin Med Assoc, 76, 419-24. https://doi.org/10.1016/j.jcma.2013.04.010
  12. Liu PH, Lee YH, Hsia CY, et al (2014). Surgical resection versus transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombosis: a propensity score analysis. Ann Surg Oncol, 21, 1825-33 https://doi.org/10.1245/s10434-014-3510-3
  13. Llovet JM, Bru C, Bruix J (1999). Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis, 19, 329-38. https://doi.org/10.1055/s-2007-1007122
  14. Llovet JM, Ricci S, Hilgard P, et al (2008). Sorafenib in advanced hepatocellular carcinoma. N Engl J Med, 359, 378-90. https://doi.org/10.1056/NEJMoa0708857
  15. Mittal S, El-Serag HB (2013). Epidemiology of hepatocellular carcinoma consider the population. J ClinGastroenterol 47, 2-6.
  16. Nuzzo G, Vauthey JN, Choti MA, et al (2013). A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC East-West study group. Ann Surg, 257, 929-937 https://doi.org/10.1097/SLA.0b013e31828329b8
  17. Omran D A, Awad A H, Mabrouk M A, et al (2015). Application of data mining techniques to explore predictors of HCC in Egyptian patients with HCV-related chronic liver disease. Asian Pac J Cancer Prev, 16, 23-27 https://doi.org/10.7314/APJCP.2015.16.1.23
  18. Poon RT, Fan ST, Tsang FH, Wong J (2002). Locoregional therapies for hepatocellular carcinoma: a critical review from the surgeon's perspective. Ann Surg, 235, 466-486 https://doi.org/10.1097/00000658-200204000-00004
  19. Poon D, Anderson BO, Chen LT, et al (2009). Management of hepatocellular carcinoma in Asia: consensus statement from the Asian Oncology Summit 2009. Lancet Oncol, 10, 1111-8 https://doi.org/10.1016/S1470-2045(09)70241-4
  20. Ruzzenente A, Capra F, Pachera S, et al (2009). Is liver resection justified in advanced hepatocellular carcinoma? Results of an observational study in 464 patients. J Gastrointest Surg, 13, 1313-20 https://doi.org/10.1007/s11605-009-0903-x
  21. Shaker MK, Abdella HM, Khalifa MO, El Dorry AK (2013) Epidemiological characteristics of hepatocellular carcinoma in Egypt: a retrospective analysis of 1313 cases. Liver Int, 33, 1601-6.
  22. Strickland GT, Elhefni H, Salman T, et al (2002). Role of hepatitis C infection in chronic liver disease in Egypt. Am J Trop Med Hyg, 67, 436-42. https://doi.org/10.4269/ajtmh.2002.67.436
  23. Tokushige K, Hashimoto E, Yatsuji S, et al (2010). Prospective study of hepatocellular carcinoma in nonalcoholic steatohepatitis in comparison with hepatocellular carcinoma caused by chronic hepatitis C. J Gastroenterol, 45, 960-7. https://doi.org/10.1007/s00535-010-0237-1
  24. Yang T, Lau WY, Zhang H, et al (2015). Grey zone in the Barcelona Clinic Liver Cancer Classification for hepatocellular carcinoma: Surgeons' perspective. World J Gastroenterol, 21, 8256-61 https://doi.org/10.3748/wjg.v21.i27.8256
  25. Yau T, Tang VY, Yao TJ, et al (2014). Development of Hong Kong Liver cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterol, 146, 1691-700. https://doi.org/10.1053/j.gastro.2014.02.032