Authors: Georgios C Sotiropoulos Nina Drühe George Sgourakis Ernesto P Molmenti Susanne Beckebaum Hideo A Baba Gerald Antoch Philip Hilgard Arnold Radtke Fuat H Saner Silvio Nadalin Andreas Paul Massimo Malagó Christoph E Broelsch Hauke Lang
Publish Date: 2008/12/05
Volume: 54, Issue: 10, Pages: 2264-2273
Abstract
The aim of the study was to evaluate our institutional experience with monotherapies for hepatocellular carcinoma HCC in the setting of cirrhosis A retrospective cohort study was carried out at the tertiary care academic referral center and involved 185 consecutive HCC patients with cirrhosis and no previous treatment who underwent resection n = 61 transarterial chemoembolization TACE n = 64 or liver transplantation LT n = 60 Longterm survival and survival according to the Milan criteria were the main outcomes measured Median survival after resection TACE and LT was 11 14 and 23 months respectively Fiveyear cumulative survival after resection TACE and LT was 23 10 and 59 respectively P = 0001 Fiveyear cumulative diseasefree survival after resection and LT was 15 and 77 respectively P = 0002 The presence of complications in the resection group P = 0004 MELD score P = 00003 and maximum tumor diameter P = 005 in the TACE group and tumor grade P = 001 and complications P = 0004 in the LT group were found to be independent predictors of survival Fiveyear survival for patients within the Milan criteria after resection TACE and LT was 26 37 and 66 respectively Fiveyear survival for patients outside the Milan criteria for patients undergoing LT was 53 The results suggest that LT represents the best oncological treatment option for patients with HCC in the setting of cirrhosis even for those beyond the Milan criteria Considering the scarcity of available organs liver resection remains the best alternative option TACE remains a potential therapy in patients within the Milan criteria where it may be more beneficial than resection
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