ABSTRACT
BACKGROUND: We evaluated changes in therapy and outcome for patients with hepatocellular carcinoma (HCC) over time in a large cohort of Western patients managed at one U.S. medical center. METHODS: A retrospective analysis of all patients with HCC treated at one U.S. medical center was performed. Analyses were stratified by time intervals 1990-1996 (pre-Milan) and 1997-2004 (post-Milan) to examine impact of UNOS criteria adapted from the post-Milan experience with OLT on treatment and survival. RESULTS: From 1990 to 2004, 501 patients were identified, 170 (34%) pre-Milan and 331 (66%) post-Milan. Seventy-four (15%) underwent OLT, 99 (20%) had partial hepatectomy (PH), 51 (10%) had ablative therapy (Ablate), 84 (16%) had embolic treatment (Embo), and 194 (39%) had chemotherapy or supportive care (C/SC). Median survival for all patients was 11 months. By time interval, median overall survival (OS) was better for post-Milan patients as compared with the pre-Milan group (13 months vs. 7 months, P = 0.02). On multivariate analysis OLT had the strongest association with improved survival of all factors examined (Odds ratio 12.4, 95% CI 7.7-20.5). CONCLUSIONS: In this series, treatment post-1996 is associated with improved survival, likely due to improvements in selection criteria and outcomes for liver transplantation.