Is there a survival benefit in interventional radiology for hepatocellular carcinoma in patients with Child-Pugh C liver cirrhosis?: A multicenter study

Atsushi Hiraoka; Takashi Kumada; Kojiro Michitaka; Hidenori Toyoda; Toshifumi Tada; Toru Ishikawa; Ei Itobayashi; Noritomo Shimada; Koichi Takaguchi; Daichi Takizawa; Kunihiko Tsuji; Hiroaki Nagamatsu, on behalf of the Real-life Practice Experts for HCC (RELPEC) Study Group

doi:10.1111/hepr.12583

Is there a survival benefit in interventional radiology for hepatocellular carcinoma in patients with Child-Pugh C liver cirrhosis?: A multicenter study

Hepatol Res. 2016 May;46(6):521-8. doi: 10.1111/hepr.12583. Epub 2015 Oct 2.

Affiliations

¹ Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
² Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
³ Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan.
⁴ Department of Gastroenterology, Asahi General Hospital, Asahi, Japan.
⁵ Division of Gastroenterology and Hepatology, Ootakanomori Hospital, Kashiwa, Japan.
⁶ Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
⁷ Department of Internal Medicine, Isezaki Municipal Hospital, Isezaki, Japan.
⁸ Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.

PMID: 26331402
DOI: 10.1111/hepr.12583

Abstract

Aim: A lack of donors in liver transplantation (LT) for hepatocellular carcinoma (HCC) has become a big issue. There is no consensus regarding whether interventional radiology for HCC in patients with Child-Pugh C liver cirrhosis will improve prognosis. To elucidate the effectiveness of such treatment, we evaluated the clinical features of affected patients.

Methods: Patients with naive HCC of Child-Pugh C (n = 236) were enrolled. Two of them were treated with LT after transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) were used as bridging treatments. After exclusion of a total of three patients who received LT, we evaluated clinical factors related to improved prognosis.

Results: The percentage of all patients with total bilirubin of less than 3 mg/dL was 41.1%. The prognosis of patients who were received treatments (n = 30; ablative therapy 10, TACE 20) was better than non-treated patients (n = 18; mean survival time [MST] 22.2 vs 13.8 months, P = 0.021, respectively) in patients with up to 7 criteria and total bilirubin of less than 3 mg/dL (n = 48). On the other hand, there was no difference in prognosis between those who underwent ablative therapies (n = 10) and those who received TACE (n = 20) (MST 22.2 vs 16.9 months, P = 0.390).

Conclusion: Therapy for HCC may prolong survival in patients with naive HCC, with up to 7 criteria and total bilirubin of less than 3 mg/dL.

Keywords: decompensated liver cirrhosis; hepatocellular carcinoma; radiofrequency ablation; total bilirubin; transcatheter arterial chemoembolization.