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


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.


HCC;performance status;aggressive treatment;outcome;prognosis


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