Treatment and prognosis of hepatocellular carcinoma: A population based study in France

Abstract

Objective Few data are available from population‐based statistics on hepatocellular carcinoma (HCC). The aim of this study was to report on their management and their prognosis in a French population. Methods Between 1997 and 1998, 1,007 cases of HCC were registered in nine French departments: clinical presentation of patients with and without cirrhosis were compared as well as treatment. Prognosis was determined using crude and relative survival rates. A multivariate relative survival analysis was performed. HCC was associated with cirrhosis in 795 patients (79%) and to the absence of cirrhosis in 156 (15%). Results Whereas the presence of symptoms was the principal mode of discovery (63% of cirrhotic cases and 70% of non‐cirrhotic cases), the follow‐up of hepatic affections revealed the cancer in respectively 26% and 3% (P = 0.001). The diagnosis was histologically verified in 50% of cirrhotic patients and 80% of non‐cirrhotic patients (P = 0.01). The size of tumours was significantly greater in non‐cirrhotic than in cirrhotic cases (P = 0.004). Treatment for cure were implemented in respectively 15% and 30% (P = 0.001), resulting in 5‐year survival rates of respectively 34% and 28%. Only 24 HCC cases received a liver transplant, with a 5‐year survival rate of 60%. Surgical resection for cure was carried out in respectively 10% and 31% of HCC and HCNC cases (P = 0.001), with a 5‐year survival rate of respectively 39% and 29%. The overall 5‐year survival rates of HCC and HCNC were respectively 6% and 9%. Conclusion HCC with and without cirrhosis has a poor prognosis with the majority of patients receiving palliative treatments, the efficiency of which is very limited. Considerable efforts are needed to develop primary and secondary prevention. J. Surg. Oncol. 2008;98:505–509.