Multimodality treatment of hepatocellular carcinoma in a hepatobiliary specialty center
A. Marcos-Alvarez, R. L. Jenkins, W. K. Washburn, W. D. Lewis, K. E. Stuart, F. D. Gordon, R. A. Kane and M. E. Clouse
Division of Hepatobilaiary Surgery, Deaconess Hospital, Harvard Medical School, Boston, Massachusetts, USA.
OBJECTIVES: To review the experience of the treatment of hepatocellular
carcinoma by a single multimodality team during a 6-year period, including
all patients who were referred for possible surgical intervention, to
evaluate prognostic factors at presentation, and to determine the results
of the different modalities of treatment that were used. DESIGN:
Retrospective study of 154 patients who were referred to our Hepatobiliary
Surgical Unit with the diagnosis of hepatocellular carcinoma from January
1988 through August 1995. SETTING: Tertiary care center. RESULTS: Methods
of treatment included surgical resection (n=49), transplantation (n=22),
hepatic artery chemoembolization (n=30), systemic chemotherapy (n=25), and
no treatment (n=22). Predictive prognostic factors included coexisting
cirrhosis, symptoms at presentation, and abnormal liver function test
results. Unfavorable tumor characteristics were size (diameter, >5 cm)
and multicentricity. For patients who underwent surgical exploration,
advanced staging according to the manual of the American Joint Committee on
Cancer, vascular invasion, and a margin of less than 1 cm in the group for
patients who underwent resection impacted negatively on the prognosis. The
median survival (42.4 months) for the group of patients who underwent
resection was significantly higher than that for the groups of patients who
did not undergo resection. Chemoembolization was associated with
significantly better survival results than was systemic chemotherapy.
CONCLUSIONS: Hepatic resection offers the best chance at cure for patients
with hepatocellular carcinoma. The high association between hepatocellular
carcinoma and cirrhotic liver disease makes surgical resection, even in
favorable tumor types, a difficult task based on low hepatic reserve whose
tumors are considered unresectable can be considered for chemoembolization.
Liver transplantation should be reserved for selected patients with
cirrhotic liver disease who have tumors (diameter, <5 cm) in the contest
of neoadjuvant protocols.
