International Journal of Hematology and Oncology 2020, Vol 30, Num 2 Page(s): 094-102
The Effects of Different Treatment Modalities on the Disease Course and Survival in Patients with Hepatocellular Cancer

Sahin LACIN1, Yusuf KARAKAS2, Omer DIZDAR2, Saadettin KILICKAP2, Manal M. HASSAN3, Lianchun XIAO4, Ahmed O. KASEB5, Suayib YALCIN2

1Yeditepe University Faculty of Medicine, Department of Medical Oncology, Istanbul, Turkey
2Hacettepe University Cancer Institute, Department of Medical Oncology, Ankara, Turkey
3University of Texas, MD Anderson Cancer Center, Department of Epidemiology, Houston, USA
4University of Texas, MD Anderson Cancer Center, Department of Biostatistics, Houston, USA
5University of Texas, MD Anderson Cancer Center, Department of Gastrointestinal Medical Oncology, Houston, USA

Keywords: Alpha-fetoprotein, Hepatocellular cancer, Local ablative treatment, Portal vein thrombosis, Tyrosine kinase inhibitor
The overall survival rate of patients with hepatocellular carcinoma (HCC) is still poor, and development of innovative therapy modalities is of crucial importance. We aimed to evaluate the efficacy of available treatment modalities and investigate their impact on survival. Patients with HCC were included to the study. Disease stages were determined according to the most commonly used classification systems. Treatment modalities for patients were determined as local ablative, local palliative, surgery, systemic cytotoxic treatment, tyrosine kinase inhibitors, and best supportive care (BSC).Among 100 patients, 81 were men and 19 were women, the median age was 64. According to the Barcelona Clinic Liver Cancer staging system (BCLC), 1% of the patients were at very early stage, 16.3% early-stage, 22.4% intermediate-stage, 56.1% advanced-stage, and 4.1% was at the terminal-stage. We observed significant difference with regards to overall survival (OS) rates among different disease stage (p< 0.001). Portal vein tumor thrombosis (PVTT) was reported in 42 patients, and the OS rate of patients with PVTT was poor (p= 0.001). Among the first-line treatments, 9 patients received local ablative therapy, 25 local palliative, 27 systemic cytotoxic, 12 tyrosine kinase inhibitors, 10 surgical resection, and 4 BSC. The difference with regards to OS ratios of treatment groups was significant (p< 0.0001).We observed differential impact of diverse treatment modalities on survival of HCC patients. The study also revealed importance of various factors such as tumor size, disease stage, serum alpha-fetoprotein level, hepatic function status, and tumor vascular invasion status on clinical outcome.