Clinical effects of different treatment regimens for Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma and influencing factors for prognosis

Objective To investigate the clinical effects of different treatment regimens for Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) and influencing factors for prognosis. Methods A retrospective analysis was performed for the clinical data of 91 patients with BCLC stage C HCC who were diagnosed and treated in The Affiliated Tumor Hospital of Guangxi Medical University from January 2005 to December 2012. According to the treatment regimen, these patients were divided into transarterial chemoembolization (TACE) group with 20 patients, TACE + sorafenib group with 18 patients, TACE + ablation group with 17 patients, surgery + TACE group with 20 patients, and surgery + TACE + ablation group with 16 patients. The patients were followed up to record survival and death time, and survival time was compared between groups. The chi-square test was used for comparison of categorical data between groups, and an analysis of variance was used for comparison of continuous data between groups. The Kaplan-Meier method was used to plot overall survival curves, and the log-rank test was used for comparison of cumulative survival rates. The Cox regression model was used for univariate and multivariate analyses. Results A total of 91 HCC patients were enrolled, and follow-up ended on November 1, 2016, with a follow-up rate of 100%. The univariate analysis showed that age, extrahepatic metastasis, tumor type, maximum tumor diameter, and treatment regimen were influencing factors for the prognosis of BCLC stage C HCC (all P < 0. 05) , and the multivariate analysis showed that age (P =0. 019) , maximum tumor diameter (P = 0. 018) , extrahepatic metastasis (P = 0. 026) , and treatment regimen (P = 0. 006) were independent influencing factors for the prognosis of HCC. There was a significant difference in overall survival between groups (χ2= 22. 841, P < 0. 001) . The surgery + TACE + ablation group had a significantly longer overall survival time than the other four groups (all P < 0. 05) ;the TACE + ablation group had a significantly longer overall survival time than the TACE group and the TACE + sorafenib group (P < 0. 05) ;the surgery + TACE group had a significantly longer overall survival time than the TACE group and the TACE + sorafenib group (P < 0. 05) .Conclusion Age, maximum tumor diameter, extrahepatic metastasis, and treatment regimen are independent influencing factors for the prognosis of BCLC stage C HCC. Surgical treatment should be selected for resectable stage C HCC, and TACE should be performed after surgery to prevent recurrence. TACE or ablation should be performed after recurrence, and surgical resection can be performed again when possible. TACE combined with ablation should be performed for unresectable stage C HCC, and the advantages of these two treatment methods can improve overall survival time.