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Sarkar et al. Predictors of survival in HCC treatment

transplantation (LT). LT is viewed as the optimal HCC diagnosis
treatment for HCC as it treats both the tumor and the Patients with either a histological or clinical diagnosis
[3]
underlying liver disease. However, the inadequate of HCC were considered for inclusion. Histological
number of available donors significantly limits use diagnosis of HCC was made either from liver biopsy
of LT. Prolonged waiting times lead to dropout from or examination of the resected liver. Patients without
the waiting list due to tumor progression exceeding histologic diagnosis, but a history of chronic liver
[4]
criteria for LT, or death due to liver failure. While disease, mass > 2 cm in size on dynamic imaging and
overall survival (OS) and recurrence-free survival are one of the following (1) arterial uptake with venous
both higher in patients undergoing LT compared to washout seen on computed tomography scan or
HR, prior studies have found that resection in patients magnetic resonance imaging or (2) alpha-feto protein
with a single tumor less than 3.0 cm in size may (AFP) > 200 ng/mL.
have comparable survival to those undergoing LT. [5]
Similarly, radiofrequency ablation (RFA), while not a Study design
curative therapy, is a safe and effective alternative to Inclusion criteria were the following: (1) patients with
HR in patients who are not surgical candidates. Direct a single tumor ≤ 3.0 cm; (2) treatment with HR, RFA,
comparisons of overall survival between HR and RFA or LT; and (3) either minimum follow-up of at least 5
are limited by the degree of hepatic dysfunction in the years or death prior to the 5-year mark. We excluded
patients who are offered resection versus ablation, but
retrospective studies suggest that survival after RFA 865 patients with multiple tumors or tumors ≥ 3.0 cm.
may not differ significantly from that of HR in certain Of the remaining 185 patients, 69 were lost to follow-
patient populations. [6,7] up prior to the 5-year mark or were enrolled less than 5
years prior to the time of data analysis and 22 received
Prognosis is also affected by the degree of hepatic another therapy (chemoembolization, Yttrium-90 or
dysfunction, patient comorbidities, and tumor biology. sorafenib) or no therapy. The final study population
included 94 patients: 55 patients underwent RFA as
Increasing evidence suggests that tumor size is their sole therapy, 16 underwent HR and 23 had LT.
a surrogate marker of tumor biology and surgical
outcomes. Tumors less than 3.0 cm have been shown Demographic/medical data were collected
to be well-differentiated, contained within the capsule prospectively via clinical interview and chart analysis,
[8]
and have better prognosis. Smaller tumors have a and the data retrospectively analyzed. Patient
higher likelihood of being successfully treated by non- characteristics chosen for analysis were: age ≤ 50
transplant therapies. Therefore, our goal is to identify years, age ≤ 60 years, gender, presence of hepatitis
characteristics in patients with small HCC (≤ 3.0 cm) B and/or hepatitis C, alcohol use (defined as 2 or more
that predict comparable long-term survival after HR alcoholic drinks/day for 10 years), obesity [defined
or RFA versus LT, as these patients may be able to as body mass index (BMI) ≥ 30], smoking, diabetes
undergo non-transplant therapy and allow allocation mellitus, AFP (stratified as normal versus abnormal
of donor livers to those most in need. with normal < 20 ng/dL), tumor size ≤ 1.5 cm, presence
of cirrhosis, serum bilirubin ≤ 1.2 mg/dL, albumin ≥
METHODS 2.5 g/dL, albumin ≥ 3.0 g/dL, international normalized
ratio (INR) ≤ 1.2, INR ≤ 1.7, presence of ascites,
Patients Child-Turcotte-Pugh (CTP) score ≤ A, CTP score ≤ B,
This is a retrospective analysis of 94 patients out platelet count ≥ 100, creatinine ≤ 1.0 mg/dL, AST-to-
of a cohort of 1,050 HCC cases referred over a 22- platelet ratio index (APRI) ≤ 0.5, APRI ≤ 1, and MELD
year period (1993-2014) to our group of physicians score < 10. Laboratory data used for the study was
associated with the only liver transplant program in obtained within 2 weeks of the initial visit. Exception
Hawaii, and the only referral center for liver disease/ points were added to the MELD scores of patients
surgery for American territories of the Pacific Basin with HCC whose tumors met Milan criteria, in order to
(including Samoa, Guam, Saipan, and the Marshall balance their risk of tumor progression and dropout
Islands). Patients also included foreign nationals from to that of non-HCC patients. Because the number
China, Japan, Korea, and the Philippines, who sought of added exception points fluctuated throughout
medical care in the USA. About 75% of the overall the study period based on united network for organ
cohort had some type of viral hepatitis with about 41% sharing guidelines, the raw MELD score rather than
with hepatitis C, 38% hepatitis B and 4-5% coinfected the adjusted MELD score was used in the analysis for
with both. This center sees about 65-70% of the HCC consistency. APRI was categorized based on initial
[9]
cases in Hawaii. This study was approved by the description by Wai et al. Of patients with an APRI of
University of Hawaii Institutional Review Board. ≤ 0.5, 85% would not have significant fibrosis (defined
80 Hepatoma Research ¦ Volume 3 ¦ May 09, 2017