Effect of Treatment Cost and Methods on Survival in Hepatocellular Carcinoma

Year 2024, Volume: 14 Issue: 1, 80 - 86, 30.04.2024

Neziha Ulusoylar Erken Filiz Araz Ertuğrul Erken Birol Özer

Abstract

Aim: Survival data for patients with hepatocellular carcinoma (HCC) is heterogeneous. We aimed to analyze the survival and cost of treatment in cirrhotic patients with HCC.
Materials and methods: From May 1998 to March 2015, 157 patients with HCC diagnosed and treated in a single center were assessed retrospectively. Etiology, biopsy findings, Child-Pugh- Turcotte (CPT) scores, Barcelona Clinical Liver Cancer (BCLC) stages, treatment response, cost, and prognostic factors were recorded. Deaths due to complications of cirrhosis or other diseases were excluded.
Results: 157 patients (82.8% male) with a mean age of 62.2±11.4 years at diagnosis were included. Etiology was HBV (56%), HCV (26.1%), cryptogenic (11.5%), and others (6.4%). Median lesion diameter was 4 (0.5–28) cm. 1, 2, and ≥3 lesions were present in 46.5%, 19.1%, and 34.2% of patients, respectively. Treatments were as follows: palliative (n: 53), transarterial chemoembolization- TACE (n: 53), radiofrequency ablation-RF (n: 14), radioembolization (n: 3), alcohol (n: 5), and chemotherapy (n: 14). Resection (n: 9) and transplantation (n: 6) were amenable in few patients. Before treatment, 114 (72.6%) patients were in the CPT A/B group, but 93 (59.3%) of all patients were initially staged as BCLC-C/D. Overall survival was 11.6±0.9 months, with 32% probability of surviving one year. Kaplan-Meier analysis revealed that pre-treatment CPT score, BCLC stage, TACE, and resection significantly affect survival. Cox regression defined BCLC stage (stage B: HR=9.58, 95% CI=1.03–88.98, p=0.047; stage C: HR=13.41, 95% CI=1.37– 130.85, p=0.026, stage D: HR=24.72, 95% CI=2.33–262.46, p=0.008) and TACE (HR=2.36, 95% CI=1.18–4.71, p=0.015) as independent predictors of survival.
Conclusion: Treatment modalities were not significantly different in terms of cost (p=0, 656). Hepatocellular carcinoma was usually diagnosed late, and treatment modalities were similar in cost. Barcelona clinical liver cancer stage and TACE were predictive of survival.

Keywords

hepatocellular carcinoma, cirrhosis, treatment methods, survival; cost-effectiveness

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