Impact of a multimodality treatment strategy on the survival outcomes in patients with recurrent hepatocellular carcinoma

Abstract

INTRODUCTION: The prognosis of patients with tumor recurrence after hepatectomy was dismal. However, it is uncertain if recent advances in the surgical management of hepatocellular carcinoma (HCC) could also improve the survival outcomes of this condition. OBJECTIVE: To evaluate the prognostic impact of a multimodality treatment strategy for intrahepatic recurrence after hepatectomy. MATERIALS AND METHODS: Data was reviewed for 469 patients with post-hepatectomy intrahepatic recurrence who received secondary treatments from 1993 to 2008. Transarterial chemoembolization (n=128) was the mainstay of treatment during 1993-2000 i.e Era I, n=170 while re-resection(RR), radiofrequency ablation (RFA) and salvage transplantation were adopted during 2001-2008 i.e. Era II, n=299. Survival outcomes of the two eras were analyzed. RESULTS: Patients in Era II were at more advanced age (P=0.03) and had higher incidence of comorbid illness (P=0.008). There was no significant difference in liver function and tumor characteristics between the two eras. However, there was a significant increment in the number of patients receiving secondary surgical treatments from 12.9% in Era I to 36.1% in Era II (P< 0.001), with a reciprocal reduction in the number of transarterial chemoembolizations (Era I 75.3% to Era II 49.2%, P< 0.001). The most notable increment was the number of RR (Era I: 4.7% vs. Era II 14.7%) and RFA (Era I: 0% vs. Era II 21.7%). As a result, the overall median survival was improved from 41.4 months in Era I to 56.5 months in Era II (P=0.002). The 1-, 3- and 5-year overall survival rates in Era I were 81.1%, 55.6% and 36.7% and for Era II were 87.6%, 62.6% and 46.6%, respectively. CONCLUSION: Recent advances in the surgical management of HCC have also enhanced the chance for treatments of intrahepatic recurrence. A multimodality treatment strategy is imperative to improve the prognosis of patients with post-hepatectomy tumor recurrence.