Multimodal therapy for hepatocellular carcinoma: A complementary approach to liver transplantation

P. Andrew Schumacher; James J. Powell; Andrea J. MacNeill; Andrzej K. Buczkowski; Siegfried R. Erb; Stephen G. Ho; Charles H. Scudamore; Urs P. Stembrecher; Alan Weiss; Eric Yoshida; Stephen W. Chung, MD, PhD, FRCSC

Annals of Hepatology (Jan 2010)

Multimodal therapy for hepatocellular carcinoma: A complementary approach to liver transplantation

P. Andrew Schumacher,
James J. Powell,
Andrea J. MacNeill,
Andrzej K. Buczkowski,
Siegfried R. Erb,
Stephen G. Ho,
Charles H. Scudamore,
Urs P. Stembrecher,
Alan Weiss,
Eric Yoshida,
Stephen W. Chung, MD, PhD, FRCSC

Affiliations

P. Andrew Schumacher: Department of Surgery, University of British Columbia, Vancouver BC Canada; University of British Columbia, Vancouver BC Canada
James J. Powell: Department of Surgery, University of British Columbia, Vancouver BC Canada; Royal Infirmary Hospital, Edinburgh, UK
Andrea J. MacNeill: Department of Surgery, University of British Columbia, Vancouver BC Canada; University of British Columbia, Vancouver BC Canada
Andrzej K. Buczkowski: Department of Surgery, University of British Columbia, Vancouver BC Canada; University of British Columbia, Vancouver BC Canada; British Columbia Transplant, Vancouver BC Canada
Siegfried R. Erb: University of British Columbia, Vancouver BC Canada; British Columbia Transplant, Vancouver BC Canada
Stephen G. Ho: Department of Radiology, University of British Columbia, Vancouver BC Canada; University of British Columbia, Vancouver BC Canada
Charles H. Scudamore: Department of Surgery, University of British Columbia, Vancouver BC Canada; Department of Surgery, University of British Columbia, Vancouver BC Canada; British Columbia Transplant, Vancouver BC Canada
Urs P. Stembrecher: Department of Medicine, University of British Columbia, Vancouver BC Canada; University of British Columbia, Vancouver BC Canada; British Columbia Transplant, Vancouver BC Canada
Alan Weiss: Department of Medicine, University of British Columbia, Vancouver BC Canada; University of British Columbia, Vancouver BC Canada
Eric Yoshida: Department of Medicine, University of British Columbia, Vancouver BC Canada; University of British Columbia, Vancouver BC Canada; British Columbia Transplant, Vancouver BC Canada
Stephen W. Chung, MD, PhD, FRCSC: Department of Surgery, University of British Columbia, Vancouver BC Canada; University of British Columbia, Vancouver BC Canada; British Columbia Transplant, Vancouver BC Canada; Correspondence and reprint request:

Journal volume & issue: Vol. 9, no. 1
pp. 23 – 32

Abstract

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Objective. To evaluate the survival benefit of multimodal therapy for the treatment of HCC.Background. Orthotopic liver transplantation (OLT) is considered the treatment of choice for selected patients with hepatocellular carcinoma (HCC). However, donor organ shortages and patients whose HCCs exceed OLT criteria require consideration of alternate therapeutic options such as hepatic resection, radiofrequency ablation (RFA), ethanol injection (EI), transarterial chemoembolization (TACE), and chemotherapy (CTX). This study was performed to evaluate the survival benefit of multimodal therapy for treatment of HCC as complementary therapy to OLT.Methods. A retrospective review was conducted of HCC patients undergoing therapy following multidisciplinary review at our institution from 1996 - 2006 with a minimum of a 2 year patient follow-up. Data were available on 247/252 patients evaluated. Relevant factors at time of diagnosis included symptoms, hepatitis B (HBV) and C (HCV) status, antiviral therapy, Child-Pugh classification, portal vein patency, and TNM staging. Patients underwent primary treatment by hepatic resection, RFA, EI, TACE, CTX, or were observed (best medical management). Patients with persistent or recurrent disease following initial therapy were assessed for salvage therapy. Survival curves and pairwise multiple comparisons were calculated using standard statistical methods.Results. Mean overall survival was 76.8 months. Pairwise comparisons revealed significant mean survival benefits with hepatic resection (93.2 months), RFA (66.2 months), and EI (81.1 months), compared with TACE (47.4 months), CTX (24.9 months), or observation (31.4 months). Shorter survival was associated with symptoms, portal vein thrombus, or Child-Pugh class B or C. HCV infection was associated with significantly shorter survival compared with HBV infection. Antiviral therapy was associated with significantly improved survival in chronic HBV and HCV patients only with earlier stage disease.Conclusion. Multimodal therapy is effective therapy for HCC and may be used as complementary treatment to OLT.

Published in Annals of Hepatology

ISSN: 1665-2681 (Print); 2659-5982 (Online)
Publisher: Elsevier
Country of publisher: Spain
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine
Website: https://www.journals.elsevier.com/annals-of-hepatology

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