Real world for management of hepatocellular carcinoma: a large population-based study

Figures & data

Table 1. Baseline characteristics of all patients and by HCC stage.

	Total (n = 1145)	Curative-stage HCC (BCLC 0-A) (n = 470)	Noncurative-stage HCC (BCLC B-D) (n = 675)	p
Age	61.43 ± 11.67	62.03 ± 10.98	61.01 ± 12.12	.145
Male	576 (50.7%)	201 (42.8%)	375 (55.6%)	.075
Underlying disease
Chronic hepatitis B	379 (33%)	162 (34.5%)	217 (32.1%)	.412
NAFLD	309 (27.1%)	145 (30.9%)	164 (24.3%)	.014
Chronic hepatitis C	298 (25.8%)	134 (28.5%)	164 (24.3%)	.11
Alcohol	198 (17.3%)	65 (13.8%)	133 (19.7%)	.01
Hyperlipidemia	79 (6.7%)	48 (10.2%)	31 (4.6%)	<.001
Cirrhosis	1140 (98.8%)	469 (99.8%)	671 (99.4%)	.338
Child-Pugh score
Child A	568 (48.7%)	317 (67.4%)	251 (37.2%)	<.001
Child B	401 (34.4%)	130 (27.7%)	271 (40.1%)	<.001
Child C	167 (15.1%)	21 (4.5%)	146 (21.6%)	<.001
Asymptomatic	461 (39.6%)	299 (63.6%)	162 (24%)	<.001
Symptomatic
Abdominal pain	370 (32.6%)	73 (15.5%)	297 (44%)	<.001
Weight loss	190 (16.8%)	39 (8.3%)	151 (22.4%)	<.001
Jaundice	188 (16.6%)	37 (7.9%)	151 (22.4%)	<.001
Anemia	149 (13.4%)	28 (6%)	121 (17.9%)	<.001
Fever	81 (7.1%)	21 (4.5%)	60 (8.9%)	.004
GI bleeding	89 (7.9%)	25 (5.3%)	64 (9.5%)	.01
Physical finding
Hepatomegaly	286 (25%)	47 (10%)	239 (35.4%)	<.001
Splenomegaly	335 (29%)	112 (23.8%)	223 (33%)	.001
Peritonitis	71 (6.2%)	2 (0.4%)	69 (10.2%)	<.001
AFP (ng/ml)
0–20	374 (32.6%)	210 (44.7%)	164 (24.3%)	<.001
20–200	195 (17%)	97 (20.6%)	98 (14.5%)	.007
200	361 (32.1%)	86 (18.3%)	275 (40.7%)	<.001
MELD	12.68 ± 8.78	11.36 ± 9.57	13.46 ± 8.2	.012
MELD-sodium	12.77 ± 6.54	10.57 ± 4.8	14.08 ± 7.08	<.001

AFP: alpha-fetoprotein; MELD: model for end-stage liver disease; NAFLD: nonalcoholic fatty liver disease.

Figure 1. Hepatocellular carcinoma staging by BCLC criteria. BCLC: Barcelona Clinic Liver Cancer; HCC: hepatocellular carcinoma.

Table 2. Characteristics of curative-stage HCC by treatment modalities.

	RFA (n = 188)	LR (n = 98)	p	RFA (n = 188)	TACE (n = 109)	p
Age <60 years	70 (37.2%)	44 (44.9%)	.209	70 (37.2%)	57 (52.3%)	.011
Chronic hepatitis B	75 (39.9%)	36 (36.7%)	.603	75 (39.9%)	29 (26.6%)	.021
Chronic hepatitis C	51 (27.1%)	27 (27.6%)	.939	51 (27.1%)	35 (32.1%)	.362
Alcohol	19 (10.10%)	13 (13.26%)	.421	19 (10.10%)	27 (24.77%)	.008
NAFLD	61 (32.4%)	29 (29.6%)	.622	61 (32.4%)	34 (31.2%)	.823
Child-Pugh A	131 (69.7%)	90 (91.8%)	<.001	131 (69.7%)	65 (59.6%)	.078
Child-Pugh B	55 (29.3%)	7 (7.1%)	<.001	55 (29.3%)	43 (39.4%)	.072
Platelet >10*10^3/mm^3	90 (47.9%)	70 (71.4%)	<.001	90 (47.9%)	39 (35.8%)	.103
AFP (ng/ml) (%)
0–20	61.1	55.95	.224	61.1	38.88	<.001
20.1–200	25.92	22.6		25.92	28.88
>200	12.96	21.4		12.96	32.22
Tumor size (%)
<2 cm	63.6	31.5	<.001	63.6	38.29	<.001
2–3 cm	22.22	39.47		22.22	52.12
>3 cm	14.14	28.94		14.14	9.57

AFP: alpha-fetoprotein; HCC: hepatocellular carcinoma; LR: liver resection; NAFLD: nonalcoholic fatty liver disease; RFA: radiofrequency ablation; TACE: transarterial chemoembolization.

Table 3. Survival rates and median survival time of curative-stage HCC patients according to treatment modalities.

Treatment modalities	n	Median time (months)	Std. Error	95%CI		% Overall survival rate (95%CI)
				Lower	Upper	1 year	2 year	3 year	4 year	5 year
RFA	117	55	4.92	45.35	64.65	80.2 (71.7, 86.4)	65.8 (56.3, 73.7)	59.7 (49.6, 68.4)	58.3 (48.1, 67.2)	46.3 (34.5, 57.2)
LR	98	36	6.18	23.89	48.11	73.4 (63.5, 81)	58.9 (48.2, 68.1)	49.2 (38.5, 59)	37.9 (27.7, 48)	33.9 (24, 44)
RFA + Resection	11	57	6.36	44.54	69.46	100	90.9 (50.8, 98.7)	90.9 (50.8, 98.7)	72.7 (37.1, 90.3)	48.5 (16, 75.1)
RFA + TACE	49	48	3.10	41.92	54.08	91.8 (79.5, 96.8)	72.5 (57.4, 83.1)	63.5 (47.9, 75.5)	48.8 (33.4, 62.5)	34 (20.3, 48.2)
RFA + LR + TACE	11	66	8.05	50.22	81.78	100	100	80 (40.9, 94.6)	70 (32.9, 89.2)	60 (25.3, 82.7)
TACE	109	26	2.75	20.60	31.40	75.2 (65.7, 82.4)	51.9 (41.1, 61.6)	29.2 (19.2, 39.8)	17.9 (9.6, 28.4)	13.9 (6.6, 24.1)
Overall	395	40	3.47	33.20	46.80	79.7 (75.4, 83.4)	63.2 (58, 67.9)	52 (46.6, 57.2)	42.4 (36.9, 47.9)	33.8 (28.3, 39.4)

CI: confidence interval; HCC: hepatocellular carcinoma; LR: liver resection; RFA: radiofrequency ablation; TACE: transarterial chemoembolization.

Figure 2. Survival analysis of curative-stage HCC (BCLC 0-A) compared with noncurative-stage HCC (BCLC B-D). BCLC: Barcelona Clinic Liver Cancer; HCC: hepatocellular carcinoma.

Figure 3. Survival analysis of curative-stage HCC by monotherapy with RFA and resection. HCC: hepatocellular carcinoma; RFA: radiofrequency ablation.

Table 4. Real-world treatment of HCC which tumor size <3 cm.

	HR	95%CI	p
RFA	Reference	1	1
LR	1.4	0.99–1.99	.060
TACE	1.98	1.4–2.81	<.001

HR: hazard ratio; CI: confidence interval; LR: liver resection; RFA: radiofrequency ablation; TACE: transarterial chemoembolization.