To analyze different treatment strategies and prognostic factors for hepatocellular carcinoma (HCC) patients with an advanced stage.

A total of 133 consecutive HCC patients with an advanced stage were evaluated retrospectively. Twenty-four prognostic factors were counted and then evaluated using univariate and multivariate Cox regression analysis. All treatment modalities of every patient during the follow-up period were collected carefully, and were separated into three strategies: (1) conservative therapy; (2) transarterial chemoembolization (TACE) monotherapy; (3) combined therapy, including TACE combined with sorafenib therapy and TACE combined with radiation therapy. The Kaplan-Meier method, with differences in survival estimated using the Log-rank test, was used to compare different prognoses.

The median survival time of all 133 advanced HCC patients was 7.6 months, and the survival rates at 6 months, 1 year and 2 years were 57%, 30% and 12%, respectively. Multivariate analysis identified that Child-Pugh class, type of portal vein tumor thrombus (PVTT) , type of extrahepatic metastasis (EHM) and level of α-fetoprotein (AFP) were independent predictors of survival. For the treatment strategy, a combined therapy for both intrahepatic and extrahepatic tumors was superior to TACE monotherapy for advanced HCC patients. And TACE monotherapy was better than conservative treatment obviously.

Child-Pugh class, type of PVTT, type of EHM and AFP level are demonstrated to be independent predictors of survival in HCC patients with an advanced stage. For advanced HCC patients in our study, a combined therapy is better than TACE monotherapy, and TACE monotherapy is better than conservative treatment.