Hepatocellular carcinoma: Clinical study of long-term survival and choice of treatment modalities

Table 1 Baseline characteristics of the patients

Characteristics	5-yr survival group	10-yr survival group	P value
No. of patients	1516	520
Mean age (yr)	50.45 ± 12.32	50.37 ± 11.59	0.102
Female/male patients	166/1350	58/462	0.935
No. of tumors			0.000
1	1285	484
2	206	33
≥ 3	25	2
No. of treatments			0.000
Surgery	1100	410
TACE	2356	576
RFA	656	109
Mean	2.71 (4112/1516)	2.11 (1095/520)
Microvascular invasion	7	3
Histology			0.381
Well	320	104
Moderate	580	184
Poor	382	144
HBsAg			0.104
Positive	948	342
Negative	568	178
Cirrhosis			0.000
Absence	1396 (91.1%)	508 (97.7%)
Present	120 (7.9%)	12 (2.3%)
Position of lesion			0.246
Left lobe	87	126
Right lobe	1334	423
Both lobes	25	5
Lesion diameter, n (cm)			0.651
≤ 3	214 (2.26 ± 0.62)1	82 (2.27 ± 0.69)1
> 3- ≤ 5	404 (4.22 ± 0.60)1	143 (4.20 ± 0.61)1
> 5-< 10	560 (12.44 ± 1.98)1	190 (7.31 ± 1.28)1
≥ 10	338 (7.24 ± 1.40)1	105 (11.94 ± 1.80)1
Mean	1516 (6.89 ± 3.69)	520 (6.58 ± 3.44)
Child-Pugh classification			0.383
Class A	1466	505
Class B	50	15
TNM stage			0.109
I	387	90
II	1096	422
III	33	8
α-fetoprotein, ng/mL
≤ 100	712 (22.50 ± 23.59)1	261 (19.78 ± 17.93)1	0.528
100-400	186 (257.92 ± 92.89)1	48 (204.91 ± 81.92)1	0.129
≥ 400	618 (16661.32 ± 28889.57)1	211 (15302.74 ± 23346.16)1	0.853
Liver function, mean ± SD
Total bilirubin, mg/dL	19.65 ± 10.03	21.04 ± 38.16	0.080
AST, U/L	50.82 ± 26.46	51.72 ± 37.24	0.145
ALT, U/L	48.71 ± 27.35	45.32 ± 30.95	0.053
γ-glutamyltransferase, U/L	71.54 ± 43.62	64.42 ± 46.07	0.069

¹There is significant difference within each group. RFA: Radiofrequency ablation; TACE: Transcatheter arterial chemoembolization; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; HBsAg: Hepatitis B surface antigen.

Table 2 Comparison of treatment modalities between 5-year survival group and 10-year survival group for hepatocellular carcinoma

Treatment modalities by tumor type	5-yr survival group	10-yr survival group	P value between groups	P value between overall groups
No. of treatment modalities				0.092
Surgery alone	609	235
TACE alone	214	80
Surgery + TACE	458	125
TACE + RFA	85	28
Surgery + TACE + RFA	150	52
Tumor size ≤ 5 cm (maximum diameter)				0.097
Surgery alone	244 (3.53 ± 1.03)	100 (3.48 ± 1.06)	0.217
TACE alone	92 (2.59 ± 1.16)	38 (3.58 ± 1.16)	0.087
Surgery + TACE	133 (3.90 ± 1.02)	43 (3.47 ± 1.03)	0.192
TACE + RFA	72 (3.10 ± 1.16)	21 (2.93 ± 1.10)	0.824
Surgery + TACE + RFA	82 (3.88 ± 0.91)	26 (3.42 ± 0.98)	0.314
Tumor size > 5 cm (maximum diameter)				0.106
Surgery alone	365 (8.16 ± 2.27)	135 (8.532 ± 2.71)	0.130
TACE alone	122 (9.31 ± 2.94)	42 (9.36 ± 2.26)	0.925
Surgery + TACE	325 (9.59 ± 3.16)	82 (9.09 ± 2.50)	0.624
TACE + RFA	13 (11.68 ± 3.74)	7 (10.47 ± 5.59)	0.548
Surgery + TACE + RFA	68 (7.19 ± 3.02)	26 (10.65 ± 4.63)	0.131
Uninodular HCC				0.039
Surgery alone	531	223
TACE alone	178	75
Surgery + TACE	382	113
TACE + RFA	57	24
Surgery + TACE + RFA	100	50
Multinodular HCC
Surgery alone	78	12
TACE alone	36	5
Surgery + TACE	76	12
TACE + RFA	28	4		0.445
Surgery + TACE + RFA	50	2
AFP > 400 ng/mL (AFP value)				0.289
Surgery alone	280 (16053.09 ± 27804.11)	102 (18092.07 ± 26818.62)	0.450
TACE alone	66 (15876.11 ± 30406.63)	28 (10984.83 ± 18402.28)	0.270
Surgery + TACE	188 (21164.79 ± 31964.15)	47 (25114.26 ± 31807.02)	0.385
TACE + RFA	32 (742.50 ± 0.00)	12 (22597.20 ± 28745.64)	0.667
Surgery + TACE + RFA	56 (1884.33 ± 953.25)	19 (8789.88 ± 21862.41)	0.091
AFP < 400 ng/mL (AFP value)				0.065
Surgery alone	329 (45.50 ± 71.08)	133 (56.35 ± 91.86)	0.853
TACE alone	148 (38.60 ± 71.56)	52 (38.09 ± 48.30)	0.355
Surgery + TACE	270 (66.35 ± 98.86)	78 (43.02 ± 74.45)	0.738
TACE + RFA	69 (133.34 ± 145.64)	16 (44.81 ± 43.02)	0.579
Surgery + TACE + RFA	94 (96.06 ± 138.35)	33 (15.43 ± 8.21)	0.064

AFP: α-fetoprotein; TACE: Transcatheter arterial chemoembolization; RFA: Radiofrequency ablation; HCC: Hepatocellular carcinoma.

Table 3 Comparison of treatmentefficacy between the 5-year survival group and 10-year survival group for hepatocellular carcinoma

Characteristics	5-yr survival group	P value	10-yr survival group	P value	P value ​​between groups
AFP the first time before and after treatment (ng/mL)
Surgery		0.002		0.000
Before surgery	1020 (4596.63 ± 17193.11)		358 (7419.90 ± 18412.64)		0.049
After surgery	1020 (1133.25 ± 4530.36)		358 (1255.09 ± 4337.24)		0.070
TACE		0.039		0.002
Before TACE	496 (4510.68 ± 15115.73)		162 (2827.99 ± 9506.04)		0.446
After TACE	496 (1732.58 ± 7631.56)		162 (502.21 ± 1526.13)		0.711
Liver function the first time before and after treatment
Total bilirubin (mg/dL)		0.721		0.353
Before treatment	68.32 ± 58.98		19.63 ± 12.65		0.078
After treatment	67.22 ± 69.45		18.76 ± 11.56		0.120
AST (U/L)		0.983		0.730
Before treatment	51.99 ± 28.41		52.69 ± 40.86		0.137
After treatment	50.87 ± 27.50		52.42 ± 39.77		0.695
ALT (U/L)		0.104		0.262
Before treatment	52.46 ± 37.21		50.69 ± 53.10		0.291
After treatment	54.60 ± 42.26		51.16 ± 50.09		0.126
γ-glutamyltransferase (U/L)		0.366		0.017
Before treatment	19.30 ± 8.09		69.85 ± 93.75		0.122
After treatment	19.53 ± 8.32		58.79 ± 67.08		0.670
Time to first tumor recurrence or metastasis (d)		0.012		0.045
Surgery alone	90 (1031.36 ± 662.61)		38 (3246.38 ± 2047.29)		0.003
TACE alone	32 (675.64 ± 412.31)		12 (1882.77 ± 1324.08)		0.015
Surgery + TACE	225 (1012.00 ± 818.86)		70 (2778.30 ± 6296.35)		0.007
Surgery + TACE + RFA	90 (798.41 ± 492.01)		52 (2553.20 ± 1746.48)		0.016

RFA: Radiofrequency ablation; TACE: Transcatheter arterial chemoembolization; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.

Table 4 Comparison of univariate analysis for various prognostic factors between 5-year survival and 10-year survival groups for hepatocellular carcinoma

Factor	5-yr survival group		10-yr survival group
	Exp (B) 95%CI	P value	Exp (B) 95%CI	P value
Sex (men and women)	0.787 (0.678-0.913)	0.002	0.875 (0.667-1.146)	0.332
Age (yr) (< 50 and ≥ 50)	0.516 (0.462-0.575)	0.000	1.097 (0.838-1.438)	0.500
Diameter of largest tumor	0.971 (0.921-1.023)	0.274	0.961 (0.879-1.051)	0.384
Child-Pugh classification	0.070 (0.060-0.082)	0.000	0.559 (0.334-0.938)	0.028
No. of tumors	1.452 (1.284-1.642)	0.000	0.390 (0.261-0.582)	0.000
Pretreatment serum AFP level	1.041 (0.987-1.099)	0.138	0.933 (0.851-1.022)	0.137
Cirrhosis	0.832 (0.775-0.893)	0.000	10.539 (8.164-13.606)	0.000
TNM stage	0.739 (0.662-0.862)	0.000	0.911 (0.739-1.124)	0.384
Treatment methods	1.152 (1.109-1.197)	0.000	1.043 (0.975-1.115)	0.220
Microvascular invasion	1.038 (0.494-2.181)	0.922	1.233 (0.396-3.838)	0.718

AFP: α-fetoprotein; TNM: Tumor-node-metastasis.

Table 5 Comparison of multivariate analysis for various prognostic factors between 5-year survival and 10-year survival groups for hepatocellular carcinoma

Group	Sex	Age	Micro-vascular	Pretreatment	Diameter of tumor	Treatment methods	TNM stage	Child-Pugh	No. of tumors	Cirrhosis
			invasion	AFP level				classification
5-yr survival	0.344	0.004	0.033	0.080	0.211	0.000	0.001	0.000	0.040	0.000
(P value)
10-yr survival	0.983	0.962	0.370	0.783	0.847	0.215	0.695	0.029	0.025	0.000
(P value)

AFP: α-fetoprotein; TNM: Tumor-node-metastasis.