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Amadeo Marcos-Alvarez, MD; Roger L. Jenkins, MD; W. Kenneth Washburn, MD; W. David Lewis, MD; Keith E. Stuart, MD; Fredric D. Gordon, MD; Robert A. Kane, MD; Melvin E. Clouse, MD

Arch Surg. 1996;131(3):292-298.

Abstract
Objectives
To review the experience on 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 Surgery 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 of 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. Candidates with adequate 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 context of neoadjuvant protocols.

(Arch Surg. 1996;131:292-298)

Author Affiliations
From the Divisions of Hepatobiliary Surgery and Liver Transplantation (Drs Marcos-Alvarez, Jenkins, Washburn, Lewis, and Clouse), Oncology (Dr Stuart), Hepatology (Dr Gordon), and Radiology (Drs Kane and Clouse), Deaconess Hospital, Harvard Medical School, Boston, Mass.

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