Cost and survival analysis for treatment modalities in hepatocellular carcinoma

Survival data for patients with hepatocellular carcinoma (HCC) is heterogeneous. We aimed to analyze the survival and cost related with treatment in cirrhotic patients with HCC. 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, BCLC stages, treatment response, cost and prognostic factors were recorded. Deaths due to complications of cirrhosis or other diseases were excluded. 157 patients (82.8% male) with mean age of 62.2 ±11.4 years at diagnosis were included. tiology was HBV (56%), HCV (26.1%), cryptogenic (11.5%) and others (6.4%). Median esion 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), TACE (n: 53), RF (n: 14), radioembolisation (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 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 1 year. Kaplan-Meier analysis revealed pre-treatment CPT score, BCLC stage, TACE and resection as factors affecting survival significantly. 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. Treatments modalties were not significantly different for cost (p= 0,656) HCC was usually diagnosed at late stage and treatment modalities were similar in terms of cost. BCLC stage and TACE were predictive on survival.