Continuous improvement in survival outcomes of hepatocellular carcinoma over 2 decades

Abstract

Introduction: To investigate the trend of post-treatment survival outcomes of hepatocellular carcinoma (HCC) patients by analysis of a prospective cohort of 5258 patients over a 20-year period. Methods: All HCC patients who were treated in a single-university center from 1997-2016 were included. Patients were divided into two 10-year period: period 1=1997-2006 (n = 2520), period 2=2007-2016(n = 2738). Results: In period 2, patients were older (59 vs 61, p < 0.001), had more medical comorbidities (39.8% vs 48.4%, p < 0.001) and remained male predominant (80% vs 80.1%, p = 0.552). There were more screen detected HCC (25.5% vs 32.9%, p < 0.001). Overall, patients' liver function at time of diagnosis has improved (MELD 9 vs 8, p < 0.001) and indocyanine green retention at 15mins (14.1% vs 12.5%, p < 0.001). Such improvement was likely related to the wide use of hepatitis B antiviral agent since 2003. In period 2, more patients underwent surgical treatment [liver transplant: 3.4% vs 5.9%, p < 0.001), resection (28.4% vs 31.1%, p < 0.001)] but the rate of ablation was similar (9.4% vs 10.3%). The overall survival of all patients have improved with median survival from 14.4 to 21.4 months. There was improvement in survival in patients who underwent liver resection, transarterial chemoembolization, systemic treatment and palliative treatment. Post-liver transplant survivals remained excellent and were similar across the decades(5-year survival 84.7% vs 85.1%, p = 0.837). Conclusion: A continuous improvement of survival outcomes for HCC patients were observed across most treatment categories (resection, TACE, systemic therapy and palliative care). Post-transplant survival was similar as the selection criteria for HCC was consistent and restrictive.