Validity of the Barcelona clinic liver cancer (BCLC) and Hong Kong liver cancer (HKLC) staging system in determining treatment for hepatocellular carcinoma (HCC) in Singapore

Abstract

Background: Transarterial chemoembolization (TACE) alone or in association with radiofrequency ablation (RFA) is an effective bridging strategy for patients with hepatocellular carcinoma (HCC) awaiting for a liver transplant (LTx). However, cost of this therapy may limit its utilization. This study was designed to evaluate the outcomes of a protocol involving transarterial embolization (TAE), percutaneous ethanol injection (PEI) or both methods for bridging HCCs prior to LTx. Methods: Retrospective review of all consecutive adult patients who underwent a first LTx as a treatment to hepatitis C-related HCC at our institution between 2002 and 2012. Primary endpoint was patient survival. Secondary endpoint was complete tumor necrosis. Results: Forty patients were analyzed, age 58 AE 7 years. There were 23 males (57.5%). Thirty-six (90%) out of the total 40 patients were within Milan criteria. Nineteen of the total 40 patients underwent TAE bridging/downstaging procedures with or without association to PEI ablation, and 21 patients had their HCC treated only by PEI. The mean time between TAE and liver transplant date was 205 days. Median number of TAE sessions was 1. Median number of PEI sessions was 1. Complete necrosis was achieved in 19 patients (47.5%). One-, 3-and 5-year patient survival were respectively 87.5%, 75% and 69.4%. Univariate analysis did not reveal any variable to impact on overall patient survival. Conclusions: TAE, PEI or the association of both methods followed by liver transplantation comprise effective treatment strategy for hepatitis C-related HCC. This strategy should be adopted whenever TACE and/or RFA are not available options.