Treatment and prognosis of hepatocellular carcinoma: a population based study in France

Few data are available from population-based statistics on hepatocellular carcinoma (HCC). The aim of this study was to report on their management and their prognosis in a French population.

Between 1997 and 1998, 1,007 cases of HCC were registered in nine French departments: clinical presentation of patients with and without cirrhosis were compared as well as treatment. Prognosis was determined using crude and relative survival rates. A multivariate relative survival analysis was performed. HCC was associated with cirrhosis in 795 patients (79%) and to the absence of cirrhosis in 156 (15%).

Whereas the presence of symptoms was the principal mode of discovery (63% of cirrhotic cases and 70% of non-cirrhotic cases), the follow-up of hepatic affections revealed the cancer in respectively 26% and 3% (P = 0.001). The diagnosis was histologically verified in 50% of cirrhotic patients and 80% of non-cirrhotic patients (P = 0.01). The size of tumours was significantly greater in non-cirrhotic than in cirrhotic cases (P = 0.004). Treatment for cure were implemented in respectively 15% and 30% (P = 0.001), resulting in 5-year survival rates of respectively 34% and 28%. Only 24 HCC cases received a liver transplant, with a 5-year survival rate of 60%. Surgical resection for cure was carried out in respectively 10% and 31% of HCC and HCNC cases (P = 0.001), with a 5-year survival rate of respectively 39% and 29%. The overall 5-year survival rates of HCC and HCNC were respectively 6% and 9%.

HCC with and without cirrhosis has a poor prognosis with the majority of patients receiving palliative treatments, the efficiency of which is very limited. Considerable efforts are needed to develop primary and secondary prevention.