Multimodal and sequential treatment improves survival in patients with hepatocellular carcinoma

Zusammenfassung

Hintergrund & Ziele Die Therapie des hepatozellulären Karzinoms (HCC) ist hauptsächlich abhängig vom Tumorstadium und der Leberfunktion. Das Ziel dieser Studie war es, weitere Prädiktoren für das Gesamtüberleben von HCC-Patienten unter besonderer Berücksichtigung von multimodalen Therapien zu identifizieren.

Methoden 607 konsekutive HCC-Patienten, die in einer Universitätsklinik zwischen 1988 und 2011 behandelt wurden, wurden retrospektiv analysiert. Die Multivarianzanalyse erfolgte mittels logistischer und COX-Regression, das Gesamtüberleben wurde mittels Kaplan-Meier untersucht.

Ergebnisse Im Vergleich zu unimodalen Behandlungen führte eine multimodale Therapieform zu einer Verlängerung des Gesamtüberlebens bei Patienten im Stadium BCLC-A von 16 auf 26 Monate (p < 0,001), bei Patienten mit BCLC-B von 9,5 auf 16 Monate (p < 0,001), bei Patienten mit BCLC-C von 6 auf 8 Monate (p < 0,001) und im Stadium BCLC-D von 2 auf 8 Monate (nicht signifikant). Das Überleben verlängerte sich bei allen Child Pugh Scores und die Patienten profitierten von einer multimodalen Therapie unabhängig von ihrem AFP-Spiegel. Beim Vergleich der Zeitintervalle zwischen 1988 und 1999 mit 2000 – 2011 zeigte sich ein Anstieg der Rate von multimodalen/sequenziellen Behandlungen von 12,3 % auf 30 % (p 0,001) und das Gesamtüberleben aller Patienten (behandelte und nicht-behandelte) stieg von 7 Monate (1988 – 1999) auf 10 Monate (2000 – 2011, p < 0,001). In der Multivarianzanalyse war eine multimodale Behandlungsform ein unabhängiger Prädiktor für das Gesamtüberleben neben einem erhöhten Alfa-Fetoprotein, dem Child Pugh Score und dem BCLC-Stadium.

Schlussfolgerung Multimodale Behandlungen verlängern das Gesamtüberleben von HCC-Patienten und sollten bei Patienten mit einem HCC in Erwägung gezogen werden, wenn dies möglich erscheint.

Abstract

Background and aims Therapy of hepatocellular carcinoma (HCC) mainly depends on tumor stage and liver function. The aim of this study was to identify additional predictors of overall survival in HCC patients with a particular attention to multimodal therapies.

Methods Six hundred and seven consecutive HCC-patients treated in a tertiary center between 1988 and 2011 were retrospectively analyzed. Multivariate analysis was performed by logistic and Cox-regression, overall survival was analyzed by Kaplan Meier statistics.

Results In comparison to unimodal therapies, multimodal treatment increased overall survival in BCLC-A patients from 16 to 26 months (p < 0.001), in patients with BCLC-B stage from 9.5 to 16 months (p < 0.001), in BCLC-C patients from 6 to 18 months (p < 0.001), and in stage BCLC-D from 2 to 8 months (not significant). Survival increased throughout all Child Pugh scores, and patients experienced benefits from multimodal therapy irrespective of alfa-fetoprotein levels. Comparing the time span 1988 – 1999 with 2000 – 2011, the rate of multimodal/sequential treatment increased from 12.3 % to 30 % (p < 0.001), and the overall survival of all (treated and non-treated) patients increased from 7 months (1988 – 1999) to 10 months (2000 – 2011, p < 0.001). In multivariate analysis, multimodal treatment was shown to be an independent predictor for overall survival besides elevated alfa-fetoprotein, Child Pugh score, and BCLC stage.

Conclusion Multimodal therapies increase overall survival in HCC patients and should be considered in patients with HCC if practicable.

Schlüsselwörter

HCC - Multimodale Therapie - BCLC - Überleben

Key words

HCC - multimodal therapy - BCLC - survival

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