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Presentation and Treatment of Hepatocellular Carcinoma at a Tertiary Care Center in Massachusetts
Jason T. Wiseman, MD, Elan R. Witkowski, MD, YouFu Li, MD, MPH, Reza F. Saidi, MD, Jennifer F. Tseng, MD, MPH, Giles F. Whalen, MD, Nicolas Jabbour, MD, Adel Bozorgzadeh, MD, Shimul A. Shah, MD
Solid Organ Transplantation, University of Massachusetts Medical School, Worcester, MA
The incidence of hepatocellular carcinoma (HCC) is increasing in the United States. We aimed to describe the presentation and management of patients with HCC at a tertiary care center.
Methods: 472 patients presented to our institution with primary hepatic malignancies from 1/2005-12/2009. Patients with non-HCC malignancies, lack of follow up, or incomplete data were excluded (n=309), resulting in a final cohort of 163 patients. We defined therapy as resection, liver transplantation, ablation or transarterial chemoembolization. Patients who received no treatment, chemotherapy alone, or palliative therapy were grouped as no therapy (noTx). Localized HCC (LHCC) was defined as Stage I/II HCC, and disseminated HCC (DHCC) was defined as Stage III/IV. Main outcome measures were receipt of therapy and overall survival.
Results: The number of HCC referrals increased over time. Patients who presented with HCC over the five-year period were primarily male (76.7%), with a median age of 56 years. 84.2% had radiological evidence of cirrhosis. 72 patients (44.2%) presented with LHCC, of which 88.9% subsequently received therapy at our institution. 91 patients (55.8%) presented with DHCC, of whom 47 (51.7%) received therapy (p<.0001). Treatment was associated with improved median survival in both LHCC (>60 vs. 15.4 months, p<0.0001), and in DHCC (14.7 vs. 3.2 months, p<0.0001).
Conclusions: In the current era, a large proportion of patients present with multifocal and incurable HCC in a tertiary care experience in New England. The implementation of aggressive surveillance, early diagnosis, access to treatment, and multidisciplinary approach to care improved survival in HCC.
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