Locoregional Therapy for Hepatocellular Carcinoma with and without Extrahepatic Spread

Abstract

Objective This study evaluates the use of locoregional therapy in patients with hepatocellular carcinoma (HCC) with and without extrahepatic disease (EHD). 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 included patients, 39(17%) had radiologic evidence of EHD. Patients without EHD were older than those with EHD (68.8+/−10.1 vs. 65.0+/−11.7 years, p=0.04), however, underlying liver disease/function and tumor characteristics were not different. Type of locoregional therapy (HAE vs.DEB TACE, p=0.12; RFA+embolization, p=0.07) was similar. Progression occurred in 75% (169/224) of patients. Progression free survival did not differ between the two groups (13[10.3–15.7] months EHD vs.18 [14.6–21.4] months no EHD, p=0.13). 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=0.02). On multivariate analysis, systemic therapy following locoregional treatment was the only variable independently associated with PFS (HR 0.70(0.49–1.00), p=0.04) while EHD (HR 1.60(1.02–2.50), p=0.04) and tumor size (HR 1.77(1.21–2.58), p=0.003) were independently associated with worse OS. Conclusions Patients with HCC and limited EHD treated with locoregional therapy have worse OS than patients without EHD; however, PFS was not different. Use of systemic therapy following locoregional therapy was independently associated with improved PFS in this cohort and suggests further prospective studies of locoregional, systemic and combination therapies are necessary to improve outcome in this high risk population of patients.

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