Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/19852
Title: Treatment choice for early-stage hepatocellular carcinoma in real-world practice: impact of treatment stage migration to transarterial chemoembolization and treatment response on survival.
Authors: Roberts, Stuart K;Gazzola, Alessia;Lubel, John;Gow, Paul J;Bell, Sally;Nicoll, Amanda;Dev, Anouk;Fink, Michael A;Sood, Siddharth;Knight, Virginia;Hong, Thai;Paul, Eldho;Mishra, Gauri;Majeed, Ammar;Kemp, William
Affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Clinical Haematology Department, Alfred Hospital, Melbourne, Australia
Department of Gastroenterology, Eastern Health and Eastern Health Clinical School, Monash University, Melbourne, Australia
Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Australia
Department of Gastroenterology, Monash Medical Centre, Clayton, Australia
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Gastroenterology, Alfred Hospital, and Monash University, Melbourne, Australia
Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Australia
Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 5-Nov-2018
EDate: 2018-11-05
Citation: Scandinavian journal of gastroenterology 2018; online first: 5 November
Abstract: The objectives of our study were firstly to characterize the treatment stage migration phenomenon in early (Barcelona Clinic Liver Cancer [BCLC]-0/A) stage hepatocellular carcinoma (HCC) by comparing the efficacy of curative therapies with trans-arterial chemoembolization [TACE] and secondly, determining baseline and on-treatment predictors of survival. All patients within BCLC-0/A stage from six tertiary hospitals who received curative therapy with either resection, transplantation, or ablation or TACE as first-line treatment were included in the analyses. The primary endpoint was overall survival; secondary end-points were transplant-free survival and recurrence-free survival. Between January 2000 and December 2013, we identified 253 BCLC-0/A HCC patients of whom 148 (58.5%) received curative therapy and 105 (41.5%) migrated to TACE. Patients undergoing TACE had lower median survival (2.7 vs. 6.7 years; p < .0001), transplant-free survival (2.6 vs. 4.8 years; p < .0001) and recurrence-free survival (1.3 vs. 2.7 years; p < .001). On multivariate analysis treatment allocation to TACE was an independent prognostic predictor for both lower overall survival (HR 1.70, p = .04) and for HCC recurrence (HR 2.25, p < .001). The main prognostic determinant for each target outcome was Child-Pugh score. Our study confirms that curative treatments should always be preferred when applicable in early-stage HCC, but that in cases where this is not possible, TACE is a reasonable albeit inferior treatment option. In addition, it provides unique prognostic information on a significant proportion of patients with early-stage disease in whom curative therapy is not applicable.
URI: http://ahro.austin.org.au/austinjspui/handle/1/19852
DOI: 10.1080/00365521.2018.1517277
PubMed URL: 30394145
Type: Journal Article
Subjects: BCLC 0/A
survival
treatment stage migration
Appears in Collections:Journal articles

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