Treatment choice for early-stage hepatocellular carcinoma in real-world practice: impact of treatment stage migration to transarterial chemoembolization and treatment response on survival

Stuart K. Roberts, Alessia Gazzola, John Lubel, Paul Gow, Sally Bell, Amanda Nicoll, Anouk Dev, Michael A. Fink, Siddharth Sood, Virginia Knight, Thai Hong, Eldho Paul, Gauri Mishra, Ammar Majeed, William Kemp, for the Melbourne Liver Group

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: The objectives of our study were firstly to characterize the treatment stage migration phenomenon in early (Barcelona Clinic Liver Cancer [BCLC]-0/A) stage hepatocellular carcinoma (HCC) by comparing the efficacy of curative therapies with trans-arterial chemoembolization [TACE] and secondly, determining baseline and on-treatment predictors of survival. Methods: All patients within BCLC-0/A stage from six tertiary hospitals who received curative therapy with either resection, transplantation, or ablation or TACE as first-line treatment were included in the analyses. The primary endpoint was overall survival; secondary end-points were transplant-free survival and recurrence-free survival. Results: Between January 2000 and December 2013, we identified 253 BCLC-0/A HCC patients of whom 148 (58.5%) received curative therapy and 105 (41.5%) migrated to TACE. Patients undergoing TACE had lower median survival (2.7 vs. 6.7 years; p <.0001), transplant-free survival (2.6 vs. 4.8 years; p <.0001) and recurrence-free survival (1.3 vs. 2.7 years; p <.001). On multivariate analysis treatment allocation to TACE was an independent prognostic predictor for both lower overall survival (HR 1.70, p =.04) and for HCC recurrence (HR 2.25, p <.001). The main prognostic determinant for each target outcome was Child-Pugh score. Conclusions: Our study confirms that curative treatments should always be preferred when applicable in early-stage HCC, but that in cases where this is not possible, TACE is a reasonable albeit inferior treatment option. In addition, it provides unique prognostic information on a significant proportion of patients with early-stage disease in whom curative therapy is not applicable.

Original languageEnglish
Pages (from-to)1368-1375
Number of pages8
JournalScandinavian Journal of Gastroenterology
Volume53
Issue number10-11
DOIs
Publication statusPublished - 2 Nov 2018

Keywords

  • BCLC 0/A
  • survival
  • treatment stage migration

Cite this

@article{becd03d9ec0848fda7ef63c7f2cee18a,
title = "Treatment choice for early-stage hepatocellular carcinoma in real-world practice: impact of treatment stage migration to transarterial chemoembolization and treatment response on survival",
abstract = "Objective: The objectives of our study were firstly to characterize the treatment stage migration phenomenon in early (Barcelona Clinic Liver Cancer [BCLC]-0/A) stage hepatocellular carcinoma (HCC) by comparing the efficacy of curative therapies with trans-arterial chemoembolization [TACE] and secondly, determining baseline and on-treatment predictors of survival. Methods: All patients within BCLC-0/A stage from six tertiary hospitals who received curative therapy with either resection, transplantation, or ablation or TACE as first-line treatment were included in the analyses. The primary endpoint was overall survival; secondary end-points were transplant-free survival and recurrence-free survival. Results: Between January 2000 and December 2013, we identified 253 BCLC-0/A HCC patients of whom 148 (58.5{\%}) received curative therapy and 105 (41.5{\%}) migrated to TACE. Patients undergoing TACE had lower median survival (2.7 vs. 6.7 years; p <.0001), transplant-free survival (2.6 vs. 4.8 years; p <.0001) and recurrence-free survival (1.3 vs. 2.7 years; p <.001). On multivariate analysis treatment allocation to TACE was an independent prognostic predictor for both lower overall survival (HR 1.70, p =.04) and for HCC recurrence (HR 2.25, p <.001). The main prognostic determinant for each target outcome was Child-Pugh score. Conclusions: Our study confirms that curative treatments should always be preferred when applicable in early-stage HCC, but that in cases where this is not possible, TACE is a reasonable albeit inferior treatment option. In addition, it provides unique prognostic information on a significant proportion of patients with early-stage disease in whom curative therapy is not applicable.",
keywords = "BCLC 0/A, survival, treatment stage migration",
author = "Roberts, {Stuart K.} and Alessia Gazzola and John Lubel and Paul Gow and Sally Bell and Amanda Nicoll and Anouk Dev and Fink, {Michael A.} and Siddharth Sood and Virginia Knight and Thai Hong and Eldho Paul and Gauri Mishra and Ammar Majeed and William Kemp and {for the Melbourne Liver Group}",
year = "2018",
month = "11",
day = "2",
doi = "10.1080/00365521.2018.1517277",
language = "English",
volume = "53",
pages = "1368--1375",
journal = "Scandinavian Journal of Gastroenterology",
issn = "0036-5521",
publisher = "Informa UK Ltd",
number = "10-11",

}

Treatment choice for early-stage hepatocellular carcinoma in real-world practice : impact of treatment stage migration to transarterial chemoembolization and treatment response on survival. / Roberts, Stuart K.; Gazzola, Alessia; Lubel, John; Gow, Paul; Bell, Sally; Nicoll, Amanda; Dev, Anouk; Fink, Michael A.; Sood, Siddharth; Knight, Virginia; Hong, Thai; Paul, Eldho; Mishra, Gauri; Majeed, Ammar; Kemp, William; for the Melbourne Liver Group.

In: Scandinavian Journal of Gastroenterology, Vol. 53, No. 10-11, 02.11.2018, p. 1368-1375.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Treatment choice for early-stage hepatocellular carcinoma in real-world practice

T2 - impact of treatment stage migration to transarterial chemoembolization and treatment response on survival

AU - Roberts, Stuart K.

AU - Gazzola, Alessia

AU - Lubel, John

AU - Gow, Paul

AU - Bell, Sally

AU - Nicoll, Amanda

AU - Dev, Anouk

AU - Fink, Michael A.

AU - Sood, Siddharth

AU - Knight, Virginia

AU - Hong, Thai

AU - Paul, Eldho

AU - Mishra, Gauri

AU - Majeed, Ammar

AU - Kemp, William

AU - for the Melbourne Liver Group

PY - 2018/11/2

Y1 - 2018/11/2

N2 - Objective: The objectives of our study were firstly to characterize the treatment stage migration phenomenon in early (Barcelona Clinic Liver Cancer [BCLC]-0/A) stage hepatocellular carcinoma (HCC) by comparing the efficacy of curative therapies with trans-arterial chemoembolization [TACE] and secondly, determining baseline and on-treatment predictors of survival. Methods: All patients within BCLC-0/A stage from six tertiary hospitals who received curative therapy with either resection, transplantation, or ablation or TACE as first-line treatment were included in the analyses. The primary endpoint was overall survival; secondary end-points were transplant-free survival and recurrence-free survival. Results: Between January 2000 and December 2013, we identified 253 BCLC-0/A HCC patients of whom 148 (58.5%) received curative therapy and 105 (41.5%) migrated to TACE. Patients undergoing TACE had lower median survival (2.7 vs. 6.7 years; p <.0001), transplant-free survival (2.6 vs. 4.8 years; p <.0001) and recurrence-free survival (1.3 vs. 2.7 years; p <.001). On multivariate analysis treatment allocation to TACE was an independent prognostic predictor for both lower overall survival (HR 1.70, p =.04) and for HCC recurrence (HR 2.25, p <.001). The main prognostic determinant for each target outcome was Child-Pugh score. Conclusions: Our study confirms that curative treatments should always be preferred when applicable in early-stage HCC, but that in cases where this is not possible, TACE is a reasonable albeit inferior treatment option. In addition, it provides unique prognostic information on a significant proportion of patients with early-stage disease in whom curative therapy is not applicable.

AB - Objective: The objectives of our study were firstly to characterize the treatment stage migration phenomenon in early (Barcelona Clinic Liver Cancer [BCLC]-0/A) stage hepatocellular carcinoma (HCC) by comparing the efficacy of curative therapies with trans-arterial chemoembolization [TACE] and secondly, determining baseline and on-treatment predictors of survival. Methods: All patients within BCLC-0/A stage from six tertiary hospitals who received curative therapy with either resection, transplantation, or ablation or TACE as first-line treatment were included in the analyses. The primary endpoint was overall survival; secondary end-points were transplant-free survival and recurrence-free survival. Results: Between January 2000 and December 2013, we identified 253 BCLC-0/A HCC patients of whom 148 (58.5%) received curative therapy and 105 (41.5%) migrated to TACE. Patients undergoing TACE had lower median survival (2.7 vs. 6.7 years; p <.0001), transplant-free survival (2.6 vs. 4.8 years; p <.0001) and recurrence-free survival (1.3 vs. 2.7 years; p <.001). On multivariate analysis treatment allocation to TACE was an independent prognostic predictor for both lower overall survival (HR 1.70, p =.04) and for HCC recurrence (HR 2.25, p <.001). The main prognostic determinant for each target outcome was Child-Pugh score. Conclusions: Our study confirms that curative treatments should always be preferred when applicable in early-stage HCC, but that in cases where this is not possible, TACE is a reasonable albeit inferior treatment option. In addition, it provides unique prognostic information on a significant proportion of patients with early-stage disease in whom curative therapy is not applicable.

KW - BCLC 0/A

KW - survival

KW - treatment stage migration

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U2 - 10.1080/00365521.2018.1517277

DO - 10.1080/00365521.2018.1517277

M3 - Article

VL - 53

SP - 1368

EP - 1375

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

SN - 0036-5521

IS - 10-11

ER -