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Hepatocellular carcinoma in the United States. Prognostic features, treatment outcome, and survival
K E Stuart1, A J Anand, R L Jenkins
1Boston Center for Liver Cancer, Deaconess Hospital, Boston, Massachusetts, USA.
Insights
Prognostic factors for hepatocellular carcinoma (HCC) in North American patients include cirrhosis, alcohol abuse, and abnormal AFP. These indicators help predict survival, with surgery offering the best outcomes.
Area of Science:
- Hepatology
- Oncology
- Medical Prognostics
Background:
- Hepatocellular carcinoma (HCC) is a significant global health concern.
- Understanding prognostic factors is crucial for patient management and treatment strategies.
- North American patient data provides unique insights into HCC etiology and outcomes.
Purpose of the Study:
- To identify prognostic factors at presentation for hepatocellular carcinoma (HCC).
- To evaluate the survival rates of North American HCC patients.
- To compare prognostic indicators between North American and Asian HCC patient populations.
Main Methods:
- Retrospective analysis of 314 HCC patient records from 1986-1995.
- Collected data included clinical characteristics, staging, biomarkers (AFP), and treatment.
- Survival data was analyzed in relation to various prognostic indicators.
Main Results:
- Median survival for HCC patients was 10 months.
- Cirrhosis, alcohol abuse, low albumin, high bilirubin, abnormal AFP, and portal vein obstruction (PVO) correlated with shorter survival.
- Surgery offered the longest median survival (45 months), followed by chemoembolization (14 months).
Conclusions:
- Prognostic indicators for HCC in North American patients are similar to those in Asian populations, despite differing etiologies.
- Presenting clinical characteristics provide valuable prognostic information for HCC.
- Albumin, AFP, and PVO were identified as independent risk factors for HCC survival.
Background:
The purpose of this study was to investigate prognostic factors at presentation and the survival of North American patients with hepatocellular carcinoma (HCC).
Methods:
A retrospective analysis of medical records was performed for 314 patients identified through the Tumor Registry as having been evaluated for hepatocellular carcinoma at the Deaconess Hospital, Boston, Massachusetts, from 1986 through 1995. Clinical characteristics were noted, including age, sex, TNM staging, serum biochemistries, serum alpha-fetoprotein (AFP), patency of portal vasculature, cirrhosis, history of alcohol abuse, hepatitis-B or C positivity, hemochromatosis, treatment received, and ultimate survival from the date of diagnosis.
Results:
Overall median survival was 10 months. The presence of cirrhosis, a history of alcohol abuse, low albumin, high bilirubin, abnormal AFP, and portal vein obstruction (PVO) were each associated with significantly shorter survival, as was advanced stage. Only albumin, AFP, and PVO were independent risk factors by multiple regression analysis. Patients undergoing surgery had the longest median survival (45 months), followed by those receiving chemoembolization (14 months). Those patients who were untreated or received systemic chemotherapy alone had significantly shorter survivals (2-4 months).
Conclusions:
Despite the difference in the underlying etiology of HCC in this population compared with Asian patients, poor prognostic indicators are similar. In this large series of patients at a single Northeastern hospital, analysis of presenting clinical characteristics was found to offer useful prognostic information.