Current state and clinical outcome in Turkish patients with hepatocellular carcinoma

Table 1 Treatment modalities and the stage of the disease in patients with hepatocellular carcinoma

Treatment modality	Pts within expanded criteria, n (%)	Pts within Milan criteria, n (%)	Total, n	BCLC stage				Survival, n (%)
				0-A	B	C	D
Surgical resection	24 (89)	19 (70)	27	18	9	0	0	16 (59)
OLT	47 (84)	41 (73)	56	24	13	7	12	56 (100)
Percutaneous ablation	16 (94)	15 (88)	17	11	1	3	2	10 (59)
TACE	118 (69)	99 (58)	172	81	47	34	10	80 (46)
Yttrium-90	11 (58)	10 (53)	19	7	5	7	0	10 (53)
Sorafenib	3 (19)	2 (13)	16	1	2	10	3	8 (50)
No treatment	88 (37)	61 (26)	238	24	28	54	132	39 (16)

HCC: Hepatocellular carcinoma; Pts: Patients; BCLC: Barcelona Clinic Liver Cancer; OLT: Orthotopic liver transplantation; TACE: Transarterial chemoembolization.

Table 2 Baseline demographic, clinical and laboratory characteristics of patients

Characteristics
Number of patients (%)	545 (100)
Male, n (%)	449 (82)
Female, n (%)	96 (18)
Age (yr)
Mean ± SD	59.5 ± 10
Median (range)	60 (19-85)
Chronic liver disease, n (%)	532 (97.6)
Chronic viral hepatitis, n (%)	454 (83.3)
HBV (monoinfection)	287 (52.6)
HCV (monoinfection)	120 (22)
Hepatitis D	37 (6.7)
HBV + HCV co-infection	10 (1.8)
Cirrhosis, n (%)	477 (87.5)
Child A	247 (45.3)
Child B	140 (25.7)
Child C	90 (16.5)
Diagnostic method for HCC, n (%)
CT	26 (4.8)
MRI	433 (79.4)
Liver biopsy	86 (15.8)
Treatment, n (%)
No treatment	238 (43.7)
Hepatic resection	27 (5)
OLT	56 (10.3)
TACE	172 (31.5)
Yttrium-90 radioembolization	19 (3.5)
RFA	12 (2.2)
Ethanol/acetic acid ablation	5 (0.9)
Sorafenib	16 (2.9)

HBV: Hepatitis B virus; HCV: Hepatitis C virus; HCC: Hepatocellular carcinoma; CT: Computerized tomography; MRI: Magnetic resonance imaging; OLT: Orthotopic liver transplantation; TACE: Transarterial chemoembolization; RFA: Radiofrequency ablation.

Table 3 Univariate logistic regression analyses of possible predictors of extrahepatic metastasis (n = 545)

	Univariate
	OR	95%CI	P value
Total tumor diameter
≥ 5 cm	3.19	1.18-8.59	0.022
Tumor type
Solitary HCC	Reference	-	-
Multinodular HCC	1.17	0.52-2.66	0.71
Diffuse-infiltrative HCC	1.06	0.13-8.43	0.96
Vascular invasion	1.86	0.53-6.51	0.33
HBV infection	1.76	0.73-4.26	0.21
Number of nodules	1.21	0.92-1.59	0.18
Stage of liver disease
Normal or precirrhotic liver	Reference	-	-
Child-Pugh A	2.29	0.51-10.2	0.28
Child-Pugh B	1.22	0.23-6.47	0.81
Child-Pugh C	1.14	0.19-7.01	0.89
AFP level
> 100 ng/mL	1.30	0.59-2.85	0.52
> 200 ng/mL	1.59	0.72-3.50	0.25
> 400 ng/mL	1.48	0.64-3.39	0.36
> 1000 ng/mL	1.91	0.81-4.52	0.14

HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; AFP: Alfa-fetoprotein.

Table 4 Univariate and multivariate logistic regression analysis of factors associated with vascular invasion (n = 545, R² = 0.15)

Variables	Univariate			Multivariate
	OR	95%CI	P value	OR	95%CI	P value
TTD ≥ 5 cm	6.56	2.29-18.79	< 0.001	3.14	1.01-9.77	0.047
Tumor type
Solitary HCC	Reference	-	-	Reference	-	-
Multinodular HCC	2.07	1.01-4.25	0.047	1.54	0.72-3.30	0.270
Diffuse-infiltrative HCC	6.63	2.14-20.51	0.001	2.71	0.82-8.94	0.100
Extrahepatic metastasis	1.86	0.53-6.51	0.330
Etiology of liver disease
Hepatitis C	Reference	-	-	Reference	-	-
Hepatitis B	6.29	1.48-26.76	0.013	5.37	1.23-23.39	0.025
Other (non-viral)	4.52	0.89-22.91	0.069	3.76	0.72-19.74	0.120
Stage of liver disease
Normal or precirrhotic liver	Reference	-	-
Child-Pugh A	0.60	0.24-1.53	0.290
Child-Pugh B	0.53	0.18-1.52	0.240
Child-Pugh C	0.62	0.20-1.94	0.420
AFP level
> 100 ng/mL	3.77	1.79-7.96	< 0.001
> 200 ng/mL	4.18	2.05-8.52	< 0.001	2.95	1.38-6.31	0.005
> 400 ng/mL	2.81	1.43-5.52	0.003
> 1000 ng/mL	3.54	1.78-7.05	< 0.001

TTD: Total tumor diameter; HCC: Hepatocellular carcinoma; AFP: Alfa-fetoprotein.

Table 5 Univariate and multivariate Cox regression analyses of factors associated with overall survival (n = 545)

	Univariate			Multivariate
	HR	95%CI	P value	HR	95%CI	P value
Patient related factors
Age	0.99	0.98-1.01	0.360
Gender	0.82	0.60-1.10	0.180
Etiology of liver disease
Hepatitis C	Reference	-	-	Reference	-	-
Hepatitis B	1.28	0.98-1.66	0.074	0.98	0.74-1.30	0.900
Other (non-viral)	1.41	1.002-1.99	0.049	1.12	0.78-1.60	0.540
Stage of liver disease
Normal or precirrhotic liver	Reference	-	-	Reference	-	-
Child-Pugh A	1.52	0.99-2.30	0.051	1.29	0.84-1.99	0.250
Child-Pugh B	3.16	2.04-4.88	< 0.001	1.81	1.13-2.89	0.013
Child-Pugh C	10.46	6.57-16.66	< 0.001	5.35	3.24-8.83	< 0.001
Tumor related factors
Total tumor diameter ≥ 5 cm	3.07	2.40-3.93	< 0.001	1.74	1.30-2.33	< 0.001
Multinodular or diffuse-infiltrative	2.02	1.61-2.53	< 0.001	1.23	0.95-1.59	0.120
Extrahepatic metastasis	2.53	1.63-3.93	< 0.001	2.17	1.37-3.45	0.001
Vascular invasion	3.48	2.42-5.01	< 0.001	2.74	1.84-4.06	< 0.001
AFP level > 200 ng/mL	2.59	2.07-3.23	< 0.001	2.19	1.72-2.80	< 0.001
Treatment modalities vs no treatment
Surgical treatments (OLT, hepatic resection)	0.07	0.04-0.13	< 0.001	0.12	0.06-0.24	< 0.001
TACE	0.24	0.19-0.31	< 0.001	0.38	0.28-0.51	< 0.001
Yttrium-90 adioembolization	0.37	0.19-0.72	0.003	0.36	0.18-0.74	0.005
RFA	0.12	0.04-0.38	< 0.001	0.18	0.05-0.57	0.004
Ethanol/acetic acid ablation	0.60	0.22-1.63	0.318	0.79	0.28-2.22	0.660
Sorafenib	0.51	0.25-1.04	0.063	0.52	0.25-1.10	0.088

AFP: Alfa-fetoprotein; OLT: Orthotopic liver transplantation; TACE: Transarterial chemoembolization; RFA: Radiofrequency ablation.