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Sarkar et al. Predictors of survival in HCC treatment

Table 2: The 3-year and 5-year OS after LT, HR, and RFA TACE, and 6 patients who received chemotherapy
Survival LT HR RFA HR/RFA (5 patients received more than 1 treatment modality
for recurrence). Forty-four patients (including 3 out
3-year OS 82.6% 62.5% 34.5% 40.8%
of the 31 patients with recurrence) did not have any
5-year OS 73.9% 56.3% 27.3% 33.8% documented subsequent therapy, so their causes
LT: liver transplantation; HR: hepatic resection; RFA: radiofrequency of death were unclear. Among the 22 patients who
ablation; OS: overall survival underwent HR/RFA and had both MELD < 10 and
APRI ≤ 0.5, 13 patients had a documented recurrence
Patient characteristics significantly affecting (59.1%). In the remaining 49 HR/RFA patients, 18
survival patients had a documented recurrence (36.7%). Two
Patient characteristics with statistically significant of the 23 patients who underwent LT had recurrence
ORs for both 3-year and 5-year OS were: MELD < (8.7%): 1 patient had a local recurrence which
10, creatinine ≤ 1 mg/dL, and APRI ≤ 0.5 [Table 3]. was treated with RFA and sorafenib, and 1 patient
Characteristics with significant ORs inversely correlating underwent excision of a metastatic lesion on the chest
with 3-year and 5-year OS were age > 60 years and wall.
presence of diabetes. Serum bilirubin ≤ 1.2 mg/dL,
serum albumin ≥ 3.0 g/dL, and CTP score ≤ 6 The average time to recurrence among all HR/RFA
approached but did not reach significance. patients was 935 days. Among the 22 patients with
MELD < 10 and APRI ≤ 0.5, 5 patients had early
Modified OS recurrence (38.4%), and mean time to recurrence
Modified 3-year and 5-year OS was calculated was 1,107 days (range 169-3,380 days). For the
for patients who underwent HR or RFA with the other 49 HR/RFA patients, 1 patient had recurrence
characteristics in Table 3, and compared with 3-year for which time to recurrence was unknown, and 11
and 5-year survival after LT [Figure 1]. APRI ≤ 0.5 patients (64.7%) had early recurrences. The average
was associated with a 3-year OS of 68.0% and 5-year time to recurrence in this group was 803 days (range
OS of 64.0%, and MELD < 10 was associated with a 188-2,664 days). There was a trend toward late
3-year OS of 64.9% and 5-year OS of 54.1%. Patients recurrences in the low MELD/APRI group compared
who underwent HR or RFA with both MELD < 10 and to the other patients (61.5% vs. 35.3%), however this
APRI ≤ 0.5 (22 out of 71 patients) had a modified was not statistically significant (P = 0.27).
3-year OS of 77.3% and 5-year OS of 72.7%.
Diabetes mellitus was associated with a 3-year and DISCUSSION
5-year OS of 17.6% following HR/RFA.
Determining the most appropriate initial therapy for
Recurrence early HCC is challenging given the need to balance
Of the 71 patients that underwent HR/RFA, 31 patients procedural morbidity and mortality with long-term
had documented recurrence, or 43.6%. Twenty-seven recurrence rates. LT has been shown in multiple
of these 31 patients underwent subsequent treatment retrospective studies and a meta-analysis to have
including 1 patient who underwent repeat resection, superior long term, recurrence-free survival compared
16 patients who underwent RFA, 9 who underwent to HR. [10-14] However, the scarcity of donor livers is a

Table 3: Patient characteristics significantly affecting 3-year and 5-year OS
3-year OS 5-year OS
Characteristic n OR (95% CI) P value OR (95% CI) P value
MELD < 10 54 4.43 (1.85, 10.58) 0.0008 2.77 (1.19, 6.46) 0.0181
APRI ≤ 0.5 31 4.25 (1.63, 11.08) 0.0031 4.09 (1.59, 10.50) 0.0034
Creatinine ≤ 1.0 mg/dL 55 6.28 (2.09, 18.86) 0.0010 4.15 (1.39, 12.36) 0.0107
Diabetes 22 0.22 (0.07, 0.66) 0.0070 0.32 (0.11, 0.97) 0.0438
Age > 60 years 41 0.42 (0.18, 0.96) 0.0396 0.32 (0.14, 0.75) 0.0089
Bilirubin ≤ 1.2 mg/dL 46 2.28 (0.99, 5.24) 0.0520 2.19 (0.95, 5.06) 0.0677
Albumin ≥ 3.0 g/dL 67 3.50 (1.22, 10.07) 0.0201 2.36 (0.82, 6.78) 0.1093
CTP score ≤ 6 58 2.23 (0.95, 5.21) 0.0649 2.00 (0.84, 4.74) 0.1155
OS: overall survival; OR: odds ratio; CI: confidence interval; MELD: Model for End Stage Liver Disease; APRI: AST-to-platelet ratio index;
CTP: Child-Turcotte-Pugh
82 Hepatoma Research ¦ Volume 3 ¦ May 09, 2017