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Transplantation Offers Best Hope for Long-Term Survival of Liver Cancer: Presented at ASCO-GI

By Ed Susman

ORLANDO, FL -- January 22, 2007 -- Human organ transplantation gives patients with hepatocellular cancer the best chance for long-term survival, but most liver cancer patients in the United States never get the opportunity to try surgical procedures because their disease is too advance at diagnosis, researchers said here at the 43^rd Annual Meeting of the American Society of Clinical Oncology - 2007 Gastrointestinal Cancers Symposium (ASCO-GI).

About 67% of transplant patients are alive after 6 years, compared with 38% of patients who undergo resection or 19% of patients who are treated locally with percutaneous ablation procedures (P < .0001), said Rodrich Schwarz, MD, director, Pancreatic Cancer Program, and associate professor of surgery, Cancer Institute of New Jersey, New Brunswick, New Jersey.

"These data suggest that transplantation and resection should still be preferentially considered for all hepatocellular carcinoma patients," Dr. Schwarz said at a press briefing on January 20^th.

He noted that patients who receive no treatment or incomplete resection have a 5-year survival of less that 5%. Yet that group of patients represents, by far, the largest single patient cohort -- more than 20,000 people.

Dr. Schwarz said the study's findings should not be taken to show that one treatment is better than another. He said that in most cases it is the patient's condition and the extent of the cancer that determines which procedure a patient will receive.

Dr. Schwarz and colleagues reviewed data in the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database to determine outcomes in patients with a diagnosis of liver cancer treated from 1973 to 2003.

He found that 726 of the patients received a liver transplant. Charles Staley, MD, professor of surgery and chief of surgical oncology, Emory University, Atlanta, Georgia, said, "In most cases, the selection criteria for who gets a human organ transplant is most critical. It depends on size of the tumor and other factors."

Generally, the patients who are selected for transplant are among the healthiest of patients with liver cancer.

The researchers identified 2,199 patients who were treated with liver resection and 975 who underwent ablation during the period analyzed. Another 20,005 patients had no surgical treatment or incomplete resection.

Dr. Schwarz agreed that in most cases patients who are being treated with ablative therapies -- currently radiofrequency is the most common form of ablative technique-- are undergoing palliative treatments. Generally, patients undergoing palliative treatment have metastatic disease or poor performance status, he said.

"Many of the patients who we select for ablation therapy are not healthy enough to undergo general anesthesia," said Dr. Staley.

Since 1999, ablation procedures have steadily increased while resection and transplant procedures have reached a plateau, Dr. Schwarz' data demonstrated. "I think that the move to ablation procedures comes from patients for whom no surgery was considered because of the extent of the disease and from patients who would have had resections," he said.

The research indicated that attempts to perform surgery in liver cancer patients occurred infrequently and survival outcomes were likely confounded by variables.


[Presentation title: Impact of Local Therapy for Hepatocellular Carcinoma on Survival Outcomes in the U.S. Population. Abstract 105]

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