The Efficacy Of Different Treatment Mode And The Prognostic Factors Of Hepatocellular Carcinoma In BCLCC Stage

Objectives: The treatment modes of BCLC C stage hepatocellular carcinoma are varied,and at present there is still no guideline and criterion in China.This retrospective study is to analyze the different treatment methods and the prognostic factors of BCLC C stage hepatocellular carcinoma,and to discuss which are the best treatment methods and the prognostic factors.Methods: The clinical data of 111 consecutive patients were retrospectively analyzed from January 2005 to December 2012.These patients were divided into six groups according to their therapeutic methods.Group 1: TACE only(n=29);Group 2: TACE+Sorafenib(n=20);Group 3: TACE + Ablation(n=21);Group 4: Liver resection +TACE(n=24);Group 5:Liver resection + TACE+Ablation(n=17).The Kaplan-Meier method was adopted to estimate survival.The prognostic factors were evaluated by using COX hazard model.Results: In TACE only group :The median survival time in TACE only group was 16 months,the 1-,2-and 3-year survival rate was 64.7%?22.7%?0%;In TACE+Sorafenib group: The median survival time was 12 months,the1-,2-and 3-year survival rate was 46.8%?23.2%?8.8%;In TACE+Ablation group: The median survival time was more than 36 months,the 1-,2-and 3-yearsurvival rate was 70%?46.4%?46.4%;In Liver Resection +TACE group: the median survival time was 21 months.The 1-,2-and 3-year survival rate was73.7%?73.7%?59.0%;In Liver Resection+TACE+Ablation group: The median survival time was more than 19 months.The 1-,2-and 3-year survival rate was94.1%?94.1%?80.9%.Compare the data between any two groups,the results showed that: The overall survival time of Liver Resection+TACE+Ablation group was significantly higher than that of the TACE only group?TACE +Sorafenib group and Liver Resection+TACE group(P<0.05),and no statistical significance compared with TACE+Ablation group(P>0.05);The overall survival time of TACE+Ablation group was significantly higher than that of the TACE only group and TACE +Sorafenib group(P<0.05),and no statistical significance compared with Liver Resection+TACE group and Liver Resection+TACE+Ablation group(P>0.05);The overall survival time of TACE+Ablation group was significantly higher than that of the TACE only group and TACE +Sorafenib group(P<0.05),and no statistical significance compared with Liver Resection+TACE group and Liver Resection+TACE+Ablation group(P>0.05);The overall survival time of Liver Resection+TACE group was significantly higher than that of the TACE+Sorafenib group(P<0.05),and no statistical significance compared with TACE+Ablation group and TACE only group(P>0.05);the overall survival time was no statistical significance between TACE + Sorafenib group and TACE only group(P>0.05).Univariate analysis showed that there was significant difference from the age(P=0.028),the tumor gross type(P=0.041),extrahepatic metastasis(P=0.010),the tumor diameter(P=0.008),treatment methods(P=0.000).Multivariate analysis showed that the tumor diameter?extrahepatic metastasis and treatment methods are independent prognostic factors to prognostics.Conclusions: Firstly,the treatment methods ? the tumor diameter and extrahepatic metastasis are independent prognostic factors of BCLC C stage hepatocellular carcinoma;Secondly,Liver resection + TACE + Ablation can prolong the survival time of BCLC C stage hepatocellular carcinoma patients who is resectable;Thirdly,TACE + Ablation can prolong the survival time of BCLC C stage hepatocellular carcinoma patients who is unresectable;Finally,TACE+Sorafenib failed to prolong the survival time of BCLC C stage hepatocellular carcinoma patients,but it still need a larger sample?multi-center?randomized?double-blind?prospective study to prove.