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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Current state and clinical outcome in Turkish patients with hepatocellular carcinoma
Omer Ekinci, Bulent Baran, Asli Cifcibasi Ormeci, Ozlem Mutluay Soyer, Suut Gokturk, Sami Evirgen, Arzu Poyanli, Mine Gulluoglu, Filiz Akyuz, Cetin Karaca, Kadir Demir, Fatih Besisik, Sabahattin Kaymakoglu
Omer Ekinci, Asli Cifcibasi Ormeci, Ozlem Mutluay Soyer, Suut Gokturk, Sami Evirgen, Filiz Akyuz, Cetin Karaca, Kadir Demir, Fatih Besisik, Sabahattin Kaymakoglu, Department of Gastroenterohepatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey
Omer Ekinci, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey
Bulent Baran, Department of Gastroenterology, Koç University Hospital, Istanbul 34010, Turkey
Arzu Poyanli, Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey
Mine Gulluoglu, Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey
Author contributions: Ekinci O and Baran B contributed to primary investigator, acquisition, analysis and interpretation of data, statistical analysis; Ormeci AC, Soyer OM, Gokturk S and Evirgen S contributed to acquisition of data, patient recruitment; Poyanli A contributed to evaluation of radiological data; Gulluoglu M contributed to evaluation and analysis of liver specimens; Akyuz F, Karaca C, Demir K, Besisik F and Kaymakoglu S contributed to critical revision of the manuscript for important intellectual content; Kaymakoglu S contributed to mentor, primary investigator, study concept and design, study supervision; Ekinci O and Baran B contributed equally to the study.
Institutional review board statement: This study was reviewed and approved by the ethics committee of Istanbul Faculty of Medicine, Istanbul University. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki. Document no: 2010/786-24, approval date: Nov 25, 2010.
Informed consent statement: This study is a retrospective cohort study, therefore informed consent to be included in the study is not required according to the regulations of Republic of Turkey. All the treatments were established and indicated treatment modalities, and no experimental tool or medication were used in the study. Nevertheless, all patients were needed to give written permission, before undergoing specific treatments including TACE, TARE, liver transplantation, and surgical resection. In addition, according to the regulations of Istanbul University, at admission all patients give informed consent for their medical information can be used for research purposes anonymously.
Conflict-of-interest statement: All authors declare that there are no financial or other relationships that might lead to a conflict of interest.
Data sharing statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sabahattin Kaymakoglu, MD, Professor, Department of Gastroenterohepatology, Istanbul Faculty of Medicine, Istanbul University, Cape, Istanbul 34390, Turkey.
sabahattin.kaymakoglu@istanbul.edu.tr
Telephone: +90-212-4142000 Fax: +90-212-6319743
Received: August 20, 2017
Peer-review started: August 23, 2017
First decision: December 4, 2017
Revised: December 7, 2017
Accepted: December 29, 2017
Article in press: December 29, 2017
Published online: January 27, 2018
Processing time: 54 Days and 11.9 Hours
AIM
To investigate clinical, etiological, and prognostic features in patients with hepatocellular carcinoma.
METHODS
Patients with hepatocellular carcinoma who were followed-up from 2001 to 2011 were included in the study. The diagnosis was established by histopathological and/or radiological criteria. We retrospectively reviewed clinical and laboratory data, etiology of primary liver disease, imaging characteristics and treatments. Child-Pugh and Barcelona Clinic Liver Cancer stage was determined at initial diagnosis. Kaplan-Meier survival analysis was done to find out treatment effect on survival. Risk factors for vascular invasion and overall survival were investigated by multivariate Cox regression analyses.
RESULTS
Five hundred and forty-five patients with hepatocellular carcinoma were included in the study. Viral hepatitis was prevalent and 68 patients either had normal liver or were non-cirrhotic. Overall median survival was 16 (13-19) mo. Presence of extrahepatic metastasis was associated with larger tumor size (OR = 3.19, 95%CI: 1.14-10.6). Independent predictor variables of vascular invasion were AFP (OR = 2.95, 95%CI: 1.38-6.31), total tumor diameter (OR = 3.14, 95%CI: 1.01-9.77), and hepatitis B infection (OR = 5.37, 95%CI: 1.23-23.39). Liver functional reserve, tumor size/extension, AFP level and primary treatment modality were independent predictors of overall survival. Transarterial chemoembolization (HR = 0.38, 95%CI: 0.28-0.51) and radioembolization (HR = 0.36, 95%CI: 0.18-0.74) provided a comparable survival benefit in the real life setting. Surgical treatments as resection and transplantation were found to be associated with the best survival compared with loco-regional treatments (log-rank, P < 0.001).
CONCLUSION
Baseline liver function, oncologic features including AFP level and primary treatment modality determines overall survival in patients with hepatocellular carcinoma.
Core tip: Hepatocellular carcinoma is a leading cause of cancer-related death with curative treatment options limited to orthotopic liver transplantation, surgical resection and local ablation. Our study confirmed that liver functional reserve, tumor extension and alfa-fetoprotein level are among the most important determinants of patient survival. Survival benefit of non-curative treatments including transarterial chemoembolization and Yttrium-90 radioembolization remains an area of uncertainty. In this study we showed that transarterial chemoembolization and Yttrium-90 radioembolization provided a significant and comparable survival benefit in patients with hepatocellular carcinoma in the real-life setting. We concluded that primary modality of treatment for hepatocellular carcinoma is a major determinant of patient survival that should be incorporated while estimating prognosis.
