Predictors of treatment outcomes in early stage hepatocellular carcinoma (HCC) detected in a surveillance program
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AbstractBackground: Surveillance for HCC in hepatitis B virus (HBV) carriers aims to improve survival by detection of early resectable tumor. In 2005, our group reported low surgical resection rates despite detection of small sized tumors in a prospective surveillance cohort of 1018 HBV carriers (Mok TS et al. J Clin Oncol 05). In current study, we aim to identify predictive factors for treatment outcomes in HCC detected from our surveillance program. Methods: The prospective cohort was recruited at the Prince of Wales Hospital between Oct 1997 and Nov 2000. We updated the database in Dec 2008 and performed univariate and multivariate analysis on clinical (age, sex, cirrhosis, ascites, anti-viral therapy, bilirubin, ALT, albumin, INR), tumorous (size, number, resection) and virologic factors (HBV DNA, Genotype) for prediction of outcome in HCC patients (pts). Results: In the prospective cohort, total 923 HBV carriers were updated (95 lost to follow-up). After median follow-up of 9.95 years, we confirmed diagnosis of 105 HCC. Median age = 51 (range: 40-69); M:F = 82:23; Child's A and B cirrhosis = 38:67. Fifty seven pts (54.3%) had solitary tumor but only 34 (32.4%) are amenable to resection. Absence of cirrhosis (p=0.0072) and normal albumin level (p=0.0379) are predictors of surgical resection while tumor size and number are not. The median survival of all HCC pts was 2.26 years. Anti-viral therapy during the surveillance period is a strong predictor of survival (3.74 vs. 1.63 years; p=0.0115). In multivariate analysis, both anti- viral therapy (HR=0.35; 95%CI: 0.19-0.73; p=0.0041) and normal bilirubin level (HR=0.30; 95% CI: 0.25-0.80; p=0.0069) were predictive of improved survival in pts with HCC. The benefits of anti-viral therapy applied to both surgical and non-surgical candidates (p=0.17). Conclusions: Anti-viral therapy is a potent predictor of survival of HBV related HCC. Liver function is more important than tumor characteristics in determining the outcome of HCC detected in the surveillance program.
All Author(s) ListChan SL, Mo FK, Koh J, Hui EP, Yu SC, Lai PB, Chan HL, Chan VT, Chan AT, Yeo W, Mok T
Name of Conference45th Annual Meeting of the American-Society-of-Clinical-Oncology
Start Date of Conference29/05/2009
End Date of Conference02/06/2009
Place of ConferenceOrlando
Country/Region of ConferenceUnited States of America
Journal nameJournal of Clinical Oncology
Proceedings Title2009 ASCO Annual Meeting
Detailed descriptionorganized by ASCO,
Year2009
Month5
Day20
Volume Number27
Issue Number15
PublisherAmerican Society of Clinical Oncology
ISSN0732-183X
eISSN1527-7755
LanguagesEnglish-United Kingdom
Web of Science Subject CategoriesOncology; ONCOLOGY

Last updated on 2020-12-08 at 02:34