1. Institute of Oncology, Davidoff Center, Rabin Medical Center, Petah Tikva, Israel;
2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
3. Liver Institute; Rabin Medical Center, Petah Tikva, Israel;
4. Department of Imaging; Rabin Medical Center, Petah Tikva, Israel;
5. Department of Organ Transplantation; Rabin Medical Center, Petah Tikva, Israel;
6. Department of Pathology, Rabin Medical Center, Petah Tikva, Israel.
Background & Aims: Hepatocellular Carcinoma (HCC) is the sixth most common malignancy and the third most common cause of cancer mortality worldwide. We aimed to assess the effect of novel treatment options on the survival of HCC patients.
Methods: This retrospective study included all HCC patients diagnosed between 2000 and 2013 referred to the Davidoff center and treated by a multidisciplinary team.
Results: The analysis included 321 patients (median age, 64 years; 74.8% males; 74.1% viral carriers; 76.0% cirrhosis; 56.7% diagnosis at an early stage). The estimated hazard ratio by multivariate analysis for the effect of the period of diagnosis (2007-2013 vs. 2000-2006) on survival was 0.72 (95% CI: 0.54-0.96; p=0.027). There was no difference in the distribution by CP score, by BCLC stage at diagnosis or in the proportion of patients undergoing surgical procedures (liver transplantation or resection). In the later time frame, there was a significant decrease in the proportion of patients undergoing percutaneous treatments (14.6% vs.4.2%, p=0.004) and embolization (46.9% vs.24.6%, p=0.001), and a significant increase in radiotherapy (1.5% vs. 8.4%, p=0.009) and treatment with sorafenib (6% vs. 18.3%, p=0.002).
Conclusion: Technological/pharmaceutical innovations have led to advancement in HCC treatment. Since there was no significant difference in the proportion of patients undergoing surgical procedures during the evaluated timeframe, the improved survival may stem from better management of advanced stage patients by a multidisciplinary team.
Keywords: hepatocellular carcinoma, liver transplantation, sorafenib, retrospective study.