TY - JOUR
T1 - Prognostic factors and treatment effects for hepatocellular carcinoma in Child C cirrhosis
AU - Nouso, K.
AU - Ito, Y. M.
AU - Kuwaki, K.
AU - Kobayashi, Y.
AU - Nakamura, S.
AU - Ohashi, Y.
AU - Yamamoto, K.
PY - 2008/4/8
Y1 - 2008/4/8
N2 - The aim of this study is to elucidate the prognostic factors and the treatment effect on survival in hepatocellular carcinoma (HCC) patients with Child C cirrhosis. Out of 3330 newly discovered HCC patients, 157 consecutive HCC individuals with Child C cirrhosis were enrolled. The prognostic factors were examined by Cox proportional hazards regression analysis and their survival was compared by propensity score-matched analysis. Multivariate analysis revealed that high serum bilirubin (>3 mg dl-1), the presence of uncontrollable ascites, and a high platelet count (>8 × 104 mm-3), so-called background liver factors, as well as multiple tumours, large tumours (>3 cm), high alpha-fetoprotein (>400 ng ml -1), and the presence of portal vein thrombus, so-called tumour factors, were factors of poor prognosis. While transcatheter arterial chemoembolisation (TACE) was a factor of good prognosis (relative risk=0.50, 95%CI=0.27-0.89, P=0.019), local ablation therapy and transcatheter arterial chemoinfusion (TAI) were not significant prognostic factors. The survival of patients who received TACE was superior to matched patients without active treatment (P=0.009); however, we did not observe survival benefit after local ablation therapy or TAI. These results suggested that tumour factors as well as background liver factors are prognostic factors of HCC even in patients with Child C cirrhosis, and selective use of TACE in these patients provides survival benefit.
AB - The aim of this study is to elucidate the prognostic factors and the treatment effect on survival in hepatocellular carcinoma (HCC) patients with Child C cirrhosis. Out of 3330 newly discovered HCC patients, 157 consecutive HCC individuals with Child C cirrhosis were enrolled. The prognostic factors were examined by Cox proportional hazards regression analysis and their survival was compared by propensity score-matched analysis. Multivariate analysis revealed that high serum bilirubin (>3 mg dl-1), the presence of uncontrollable ascites, and a high platelet count (>8 × 104 mm-3), so-called background liver factors, as well as multiple tumours, large tumours (>3 cm), high alpha-fetoprotein (>400 ng ml -1), and the presence of portal vein thrombus, so-called tumour factors, were factors of poor prognosis. While transcatheter arterial chemoembolisation (TACE) was a factor of good prognosis (relative risk=0.50, 95%CI=0.27-0.89, P=0.019), local ablation therapy and transcatheter arterial chemoinfusion (TAI) were not significant prognostic factors. The survival of patients who received TACE was superior to matched patients without active treatment (P=0.009); however, we did not observe survival benefit after local ablation therapy or TAI. These results suggested that tumour factors as well as background liver factors are prognostic factors of HCC even in patients with Child C cirrhosis, and selective use of TACE in these patients provides survival benefit.
KW - Decompensated cirrhosis
KW - Hepatocellular carcinoma
KW - Prognostic factors
KW - Therapy
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UR - http://www.scopus.com/inward/citedby.url?scp=41649108003&partnerID=8YFLogxK
U2 - 10.1038/sj.bjc.6604282
DO - 10.1038/sj.bjc.6604282
M3 - Article
C2 - 18349849
AN - SCOPUS:41649108003
SN - 0007-0920
VL - 98
SP - 1161
EP - 1165
JO - British Journal of Cancer
JF - British Journal of Cancer
IS - 7
ER -