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Arch Hellen Med, 31(4), July-August 2014, 468-476


Survival of patients with hepatocellular carcinoma in Greece:
The past and present and the value of the BCLC system in real-life staging

G. Nalmpantidis,1 A. Avgerinos,1 I. Avramidis,1 D. Kapetanos,1 K. Iatrou,2 L. Sakkas,3 T. Maris,1 A. Ilias1
1Department of Gastroenterology,
2Department of Interventional Radiology,
3Department of Pathology, "Georgios Papanikolaou" General Hospital, Thessaloniki, Greece

OBJECTIVE To evaluate the survival and characteristics of patients with hepatocellular carcinoma (HCC) in two Greek cohorts, one in the distant past and one in the present, under real-life conditions.

METHOD Survival analysis was conducted, retrospectively for 11 patients with HCC diagnosed between 1928 and 1938 (group A), and for 65 patients diagnosed with HCC between 2008 and 2013 (group B). For group B the relevant data were collected partly retrospectively and partly prospectively. The Barcelona Clinic Liver Cancer (BCLC) staging system was used for patients in group B.The characteristics of the patients, the type of treatment, the interim and overall survival and the toxicity of transarterial chemoembolization (TACE) of the tumor and sorafenib were studied.

RESULTS Most of the patients with HCC were men. The mean age at diagnosis was 54.3 years in group A and 69.3 years in group B. Mean survival was 3.9 months in group A and 18 months in group B. Chronic hepatitis B (HBV) infection was the commonest risk factor in group B. Nodular HCC was the commonest type of disease in both groups. In most cases the diagnosis was based on dynamic imaging criteria. Targeted biopsy of the lesion was conducted in 16 cases (24.6%). In most patients in group B the cancer was classified as stage A. The median survival for stages A, B, C and D was 26, 24, 18 and 4 months respectively. TACE was undertaken in 38 patients (58.5%), most of who suffered from the postembolization syndrome. Sorafenib was prescribed to 16 patients (24.6%) in group B, the commonest side effects of which were diarrhea, fatigue and hand-foot syndrome. Data analysis from 11 patients (stage A or B at diagnosis) who had received TACE showed no increase in overall survival with sorafenib compared with 11 control subjects (p=0.57).

CONCLUSIONS The age at diagnosis and the overall survival of patients with HCC appear to have increased in comparison with 1928−1938. Use of the BCLC system, under real-life conditions, has helped to identify the best available treatment strategy for each patient and improve the prognosis. The toxicity of TACE and sorafenib in the study group was within the predicted range. The data analysis was not sufficiently powerful to detect overall survival benefit in patients with cancer diagnosed as stage A or B according to the BCLC system who received sorafenib after chemoembolization.

Key words: Chemoembolization, Cirrhosis, Liver cancer, Survival.

© Archives of Hellenic Medicine