Effect of Treatment Cost and Methods on Survival in Hepatocellular Carcinoma

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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