The Effectiveness of Locoregional Therapies versus Supportive Care in Maintaining Survival within the Milan Criteria in Patients with Hepatocellular Carcinoma

• Published in: Journal of vascular and interventional radiology Vol. 21; no. 8; pp. 1197 - 1204
• Main Authors: Dhanasekaran, Renumathy, MD, Khanna, Vinit, MD, Kooby, David A., MD, Spivey, James R., MD, Parekh, Samir, MD, Knechtle, Stuart J., MD, Carew, John D., PhD, Kauh, John S., MD, Kim, Hyun S., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2010
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Catheter Ablation - adverse effects; Catheter Ablation - mortality; Chemoembolization, Therapeutic - adverse effects; Chemoembolization, Therapeutic - mortality; Chi-Square Distribution; Female; Georgia; Humans; Kaplan-Meier Estimate; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Liver Transplantation; Male; Middle Aged; Neoplasm Staging; Palliative Care; Proportional Hazards Models; Radiology; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Georgia; KM; RF; CI; OLT; Kaplan Meier; radiofrequency; HCC; confidence interval; locoregional therapy; hepatocellular carcinoma; orthotopic liver transplantation; LRT
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2010.04.018

Purpose To compare survival after treatment with either locoregional therapy (LRT) or supportive care in patients with hepatocellular carcinoma (HCC) within the Milan criteria. Materials and Methods Patients with HCC who were classified within the Milan criteria (solitary HCC ≤ 5 cm or ≤ 3 tumors with none greater than 3 cm in largest diameter, and no macrovascular invasion) and underwent transcatheter therapy or radiofrequency ablation (RF ablation) between 1998 and 2008 were retrospectively studied. Patients with tumor burden within the Milan criteria who received the best supportive care only were used as the control group. Survival within the Milan criteria was compared between those who underwent LRT and patients who underwent supportive care. Results Of 162 patients studied, 110 patients (67.9%) underwent LRT, and 52 patients (32.1%) received supportive care alone. Median survival within the Milan criteria for patients who did and did not receive LRT were 644 days (95% confidence interval [CI], 193–1094) and 162 days (95% CI, 73–250) respectively ( P < .001). In patients who received LRT, Child Pugh class was prognostic for survival within the Milan criteria on multivariate analysis ( P = .002, hazard ratio 5.16 [2.69–9.89]). The long-term survival for patients who did not undergo transplant was 502 days (95% CI, 91–912) in patients who received LRT and 151 days (95% CI, 59–242) in patients who were treated with supportive care ( P < .001). Conclusions LRT is more effective than supportive care in prolonging survival within the Milan criteria in patients with HCC. The long-term survival in patients not undergoing transplant was significantly longer for patients who received LRT than for patients who were treated with supportive care.