Changing management and outcome of hepatocellular carcinoma: Evaluation of 501 patients treated at a single comprehensive center

Background We evaluated changes in therapy and outcome for patients with hepatocellular carcinoma (HCC) over time in a large cohort of Western patients managed at one U.S. medical center. Methods A retrospective analysis of all patients with HCC treated at one U.S. medical center was performed. Analyses were stratified by time intervals 1990–1996 (pre‐Milan) and 1997–2004 (post‐Milan) to examine impact of UNOS criteria adapted from the post‐Milan experience with OLT on treatment and survival. Results From 1990 to 2004, 501 patients were identified, 170 (34%) pre‐Milan and 331 (66%) post‐Milan. Seventy‐four (15%) underwent OLT, 99 (20%) had partial hepatectomy (PH), 51 (10%) had ablative therapy (Ablate), 84 (16%) had embolic treatment (Embo), and 194 (39%) had chemotherapy or supportive care (C/SC). Median survival for all patients was 11 months. By time interval, median overall survival (OS) was better for post‐Milan patients as compared with the pre‐Milan group (13 months vs. 7 months, P = 0.02). On multivariate analysis OLT had the strongest association with improved survival of all factors examined (Odds ratio 12.4, 95% CI 7.7–20.5). Conclusions In this series, treatment post‐1996 is associated with improved survival, likely due to improvements in selection criteria and outcomes for liver transplantation. J. Surg. Oncol. 2008;98:81–88. © 2008 Wiley‐Liss, Inc.