Effect of Treatment Cost and Methods on Survival in Hepatocellular Carcinoma

Yıl 2024, Cilt: 14 Sayı: 1, 80 - 86, 30.04.2024

Neziha Ulusoylar Erken , Filiz Araz Ertuğrul Erken Birol Özer

Öz

Aim: Survival data for patients with hepatocellular carcinoma (HCC) is heterogeneous. We aimed to analyze the survival and cost of treatment in cirrhotic patients with HCC.
Materials and methods: From May 1998 to March 2015, 157 patients with HCC diagnosed and treated in a single center were assessed retrospectively. Etiology, biopsy findings, Child-Pugh- Turcotte (CPT) scores, Barcelona Clinical Liver Cancer (BCLC) stages, treatment response, cost, and prognostic factors were recorded. Deaths due to complications of cirrhosis or other diseases were excluded.
Results: 157 patients (82.8% male) with a mean age of 62.2±11.4 years at diagnosis were included. Etiology was HBV (56%), HCV (26.1%), cryptogenic (11.5%), and others (6.4%). Median lesion diameter was 4 (0.5–28) cm. 1, 2, and ≥3 lesions were present in 46.5%, 19.1%, and 34.2% of patients, respectively. Treatments were as follows: palliative (n: 53), transarterial chemoembolization- TACE (n: 53), radiofrequency ablation-RF (n: 14), radioembolization (n: 3), alcohol (n: 5), and chemotherapy (n: 14). Resection (n: 9) and transplantation (n: 6) were amenable in few patients. Before treatment, 114 (72.6%) patients were in the CPT A/B group, but 93 (59.3%) of all patients were initially staged as BCLC-C/D. Overall survival was 11.6±0.9 months, with 32% probability of surviving one year. Kaplan-Meier analysis revealed that pre-treatment CPT score, BCLC stage, TACE, and resection significantly affect survival. Cox regression defined BCLC stage (stage B: HR=9.58, 95% CI=1.03–88.98, p=0.047; stage C: HR=13.41, 95% CI=1.37– 130.85, p=0.026, stage D: HR=24.72, 95% CI=2.33–262.46, p=0.008) and TACE (HR=2.36, 95% CI=1.18–4.71, p=0.015) as independent predictors of survival.
Conclusion: Treatment modalities were not significantly different in terms of cost (p=0, 656). Hepatocellular carcinoma was usually diagnosed late, and treatment modalities were similar in cost. Barcelona clinical liver cancer stage and TACE were predictive of survival.

Anahtar Kelimeler

hepatocellular carcinoma, cirrhosis, treatment methods, survival; cost-effectiveness

Kaynakça

• 1. Akyıldız, Ümit Yalçın KS. Hepatosellüler Karsinom Tedavisi. Güncel Gastroenteroloji 2010:184–189.
• 2. Bhosale P, Szklaruk J, Silverman PM. Current staging of hepatocellular carcinoma: imaging implications. Cancer Imaging. 2006;6(1):83–94.
• 3. Llovet JM, Villanueva A, Marrero JA, Schwartz M, Meyer T, Galle PR, et al. Trial Design and Endpoints in Hepatocellular Carcinoma: AASLD Consensus Conference. Hepatology. 2021;73 Suppl 1:158–191.
• 4. Kanwal F, Singal AG. Surveillance for Hepatocellular Carcinoma: Current Best Practice and Future Direction. Gastroenterology. 2019;157(1):54–64.
• 5. Bhosale P, Szklaruk J, Silverman PM. Current staging of hepatocellular carcinoma: imaging implications. Cancer Imaging. 2006;6(1):83–94.
• 6. Czauderna C, Marquardt JU, Galle PR, Wörns MA. Review of hepatocellular carcinoma: Epidemiology, etiology, and carcinogenesis. J Carcinog. 2017;16:1.
• 7. Collier J, Sherman M. Screening for hepatocellular carcinoma. Hepatology 27(1): p.273–278, January 1998.
• 8. Morgan TR, Mandayam S, Jamal MM. Alcohol and hepatocellular carcinoma. Gastroenterology. 2004;127(5 Suppl 1):S87–S96.
• 9. Arhan M, Akdo M, Yal M, Ka S, Tun B. Tek merkeze ait hepatosellüler karsinom veriler i;retrospektif çalışma. 2009;8(1):18–23.
• 10. Gilsanz Garciá V. Carcinome hépatocellulaire [Hepatocellular carcinoma]. Bull Acad Natl Med. 1989;173(3):263–282.
• 11. Bruix J, Sherman M;Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2005;42(5):1208–1236.
• 12. Hartke J, Johnson M, Ghabril M. The diagnosis and treatment of hepatocellular carcinoma. Semin Diagn Pathol. 2017;34(2):153–159.
• 13. Villanueva A. Hepatocellular Carcinoma. N Engl J Med. 2019;380(15):1450–1462.
• 14. Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118(12):3030–3044.
• 15. Can A, Dogan E, Bayoglu IV, Tatli AM, Besiroglu M, Kocer M, et al. Multicenter epidemiologic study on hepatocellular carcinoma in Turkey. Asian Pac J Cancer Prev. 2014;15(6):2923–2927.
• 16. Kew MC. Epidemiology of chronic hepatitis B virus infection, hepatocellular carcinoma, and hepatitis B virus-induced hepatocellular carcinoma. Pathol Biol (Paris) . 2010;58(4):273–277.
• 17. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391(10127):1301–1314.
• 18. Piñero F, Dirchwolf M, Pessôa MG. Biomarkers in Hepatocellular Carcinoma: Diagnosis, Prognosis and Treatment Response Assessment. Cells. 2020;9(6):1370.
• 19. Alpha-Fetoprotein Measurement Benefits Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis [published correction appears in Am J Gastroenterol. 2016;111(11):1668]. Am J Gastroenterol. 2015;110(6):836–845.
• 20. D’Avola D, Iñarrairaegui M, Pardo F, Rotellar F, Marti P, Bilbao JI, et al. Prognosis of hepatocellular carcinoma in relation to treatment across BCLC stages. Ann Surg Oncol. 2011;18(7):1964–1971.
• 21. Singal AG, Lampertico P, Nahon P. Epidemiology and surveillance for hepatocellular carcinoma: New trends. J Hepatol. 2020;72(2):250–261.
• 22. Bruix J, Sherman M;American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–1022.
• 23. European Association for The Study of The Liver;European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma [published correction appears in J Hepatol. 2012;56(6):1430]. J Hepatol. 2012;56(4):908–943.
• 24. Llovet JM, Di Bisceglie AM, Bruix J, Kramer BS, Lencioni R, Zhu AX, et al. Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst. 2008;100(10):698–711.
• 25. Johnson PJ, Billingham LJ. Clinical trial design in hepatocellular carcinoma. Best Pract Res Clin Gastroenterol. 2005;19(1):119–127.
• 26. Jianyong L, Lunan Y, Wentao W, Yong Z, Bo L, Tianfu W, et al. Barcelona clinic liver cancer stage B hepatocellular carcinoma: transarterial chemoembolization or hepatic resection? Medicine (Baltimore) . 2014;93(26):e180.
• 27. Chen S, Jin H, Dai Z, Wei M, Xiao H, Su T, et al. Liver resection versus transarterial chemoembolization for the treatment of intermediate-stage hepatocellular carcinoma. Cancer Med. 2019;8(4):1530–1539.
• 28. Lin CW, Chen YS, Lo GH, Hsu YC, Hsu CC, Wu TC, et al. Comparison of overall survival on surgical resection versus transarterial chemoembolization with or without radiofrequency ablation in intermediate-stage hepatocellular carcinoma: a propensity score matching analysis. BMC Gastroenterol. 2020;20(1):99.
• 29. Poon RT-P, Fan ST, Lo CM, Liu CL, Wong J. Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg. 2002;235(3):373–382.
• 30. Tabrizian P, Jibara G, Shrager B, Schwartz M, Roayaie S. Recurrence of hepatocellular cancer after resection: patterns, treatments, and prognosis. Ann Surg. 2015;261(5):947–955.
• 31. Parikh ND, Singal AG, Hutton DW, Tapper EB. CostEffectiveness of Hepatocellular Carcinoma Surveillance: An Assessment of Benefits and Harms. Am J Gastroenterol. 2020;115(10):1642–1649