The Management of Hepatocellular Carcinoma in the Era of Multimodal Therapy: the Experience of a Greek Tertiary Referral Center

The treatment of hepatocellular carcinoma (HCC) in the era of individualized therapy is a challenge. Treatment selection is based on the stage of the disease. Our study’s aim is to record, analyze and evaluate the demographics, therapeutics and survival of patients with HCC. We conducted a retrospective analysis between 3/1/2010 and 12/31/2018 of patients with HCC admitted to our department. The study population was 64 patients(N=64). There were 51(79,7%) males. The mean age at diagnosis was 67.8±1.25 years. Twenty-one patients(32.8%) mention heavy alcohol consumption, 26 patients(40.6%) were found positive for HBV virus and 4 patients(6.3%) for HCV virus. Thirty-two patients (50%) were treated with surgery and 29 patients(45.3%) with locoregional treatments. Out of the 32 surgical patients, 11 patients(34.3%) received locoregional treatments post-operatively for recurrence. In the locoregional group(N=29), 20 patients(68.9%) were treated with transarterial-chemoembolization(TACE), 6 patients(20.6%) with radiofrequency-ablation(RFA) and 3 patients(10.5%) with a combination. Considering survival, the 1year, 3years and 5years survival rates were 87.5%,61.5% and 32.8% in the surgery group vs 79.3%,41.1% and 0% in the locoregional group. In the surgery group, the mean overall survival of the patients treated with surgery alone was 19.01±3.33 months, compared with 47.54±6.39 months for the patients treated with surgery followed by locoregional therapy. In the locoregional group, the mean overall survival of the patients treated with TACE, RFA and their combination were found 14.49±2.92, 24.90±8.46 and 31.73±9.66 months respectively. Despite being challenged by locoregional therapy, hepatic resection remains the gold standard, as it provides higher survival rates than locoregional therapy in a statistically significant manner(p<0.05) Locoregional therapy following surgery, increases survival in a statistically significant manner compared with patients treated with surgery alone (p=0.01). The combined use of TACE and RFA appears to increase survival compared with patients treated with RFA or TACE alone, although this does not reach statistical significance.