Locoregional therapy for hepatocellular carcinoma with and without extrahepatic spread Journal Article

Authors: Leal, J. N.; Gonen, M.; Covey, A. M.; Erinjeri, J. P.; Getrajdman, G.; Sofocleous, C. T.; D'Angelica, M.; DeMatteo, R. P.; Abou-Alfa, G. K.; Jarnagin, W. R.; Fong, Y.; Brown, K. T.
Article Title: Locoregional therapy for hepatocellular carcinoma with and without extrahepatic spread
Abstract: Purpose To evaluate the use of locoregional therapy in patients with hepatocellular carcinoma (HCC) with and without extrahepatic disease (EHD). Materials and Methods Patients who underwent locoregional therapy for HCC were identified from institutional databases. Clinicopathologic and treatment characteristics were compared between patients with and without EHD. Survival and progression were assessed using the Kaplan-Meier method, and multivariate analysis was completed. Results Of 224 patients, 39 (17%) had radiologic evidence of EHD. Patients without EHD were older than patients with EHD (68.8 y ± 10.1 vs 65.0 y ± 11.7, P =.04); underlying liver disease/function and tumor characteristics were not different. Type of locoregional therapy (hepatic artery embolization vs drug-eluting bead transarterial chemoembolization, P =.12; radiofrequency ablation + embolization, P =.07) was similar. Progression occurred in 75% (169/224) of patients. Progression-free survival (PFS) did not differ between the 2 groups (13 [10.3-15.7] mo EHD vs18 [14.6-21.4] mo no EHD, P =.13). Overall survival (OS) was 13 (4.1-21.9) months and 25 (20.4-29.6) months in the EHD and no EHD groups, respectively (P =.02). On multivariate analysis, systemic therapy after locoregional treatment was the only variable independently associated with PFS (hazard ratio [HR] 0.70 [0.49-1.00], P =.04); EHD (HR 1.60 [1.02-2.50], P =.04) and tumor size (HR 1.77 [1.21-2.58], P =.003) were independently associated with worse OS. Conclusions Patients with HCC and limited EHD treated with locoregional therapy had worse OS than patients without EHD; PFS was not different. Use of systemic therapy after locoregional therapy was independently associated with improved PFS in this cohort. Further prospective studies of locoregional, systemic, and combination therapies are necessary to improve outcome in these high-risk patients. © 2015 SIR.
Keywords: aged; cancer surgery; treatment failure; major clinical study; overall survival; artificial embolism; cancer growth; chemoembolization; liver cell carcinoma; systemic therapy; bone metastasis; cancer radiotherapy; prospective study; progression free survival; data base; cancer therapy; high risk patient; lung metastasis; liver disease; multivariate analysis; kaplan meier method; radiofrequency ablation; hepatic artery; adrenal metastasis; nonalcoholic fatty liver; international normalized ratio; human; male; female; priority journal; article
Journal Title: Journal of Vascular and Interventional Radiology
Volume: 26
Issue: 8
ISSN: 1051-0443
Publisher: Elsevier Science, Inc.  
Date Published: 2015-08-01
Start Page: 1112
End Page: 1121
Language: English
DOI: 10.1016/j.jvir.2015.04.006
PROVIDER: scopus
PMCID: PMC4535717
PUBMED: 26038273
Notes: Export Date: 2 September 2015 -- Source: Scopus
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MSK Authors
  1. Ronald P DeMatteo
    597 DeMatteo
  2. Mithat Gonen
    701 Gonen
  3. Anne Covey
    118 Covey
  4. Ghassan Abou-Alfa
    219 Abou-Alfa
  5. William R Jarnagin
    583 Jarnagin
  6. Karen T Brown
    161 Brown
  7. Julie Leal
    12 Leal