MULTIMODALITY TREATMENT OF HEPATOCELLULAR-CARCINOMA IN A HEPATOBILIARY SPECIALTY CENTER

Objectives: To review the experience on the treatment of hepatocellula r carcinoma by a single multimodality team during a 6-year period, inc luding all patients who were referred for possible surgical interventi on, to evaluate prognostic factors at presentation, and to determine t he results of the different modalities of treatment that were used. De sign: Retrospective study of 154 patients who were referred to our Hep atobiliary 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), tra nsplantation (n=22), hepatic artery chemoembolization (n=30), systemic chemotherapy (n=25), and no treatment (n=22). Predictive prognostic f actors included coexisting cirrhosis, symptoms at presentation, and ab normal liver function test results. Unfavorable tumor characteristics were size (diameter, >5 cm) and multicentricity. For patients who unde rwent surgical exploration, advanced staging according to the manual o f the American Joint Committee on Cancer, vascular invasion, and a mar gin of less than 1 cm in the group of patients who underwent resection impacted negatively on the prognosis. The median survival (42.4 month s) for the group of patients who underwent resection was significantly higher than that for the groups of patients who did not undergo resec tion. Chemoembolization was associated with significantly better survi val results than was systemic chemotherapy. Conclusions: Hepatic resec tion offers the best chance at cure for patients with hepatocellular c arcinoma. The high association between hepatocellular carcinoma and ci rrhotic liver disease makes surgical resection, even in favorable turn er types, a difficult task based on low hepatic reserve. Candidates wi th adequate hepatic reserve whose tumors are considered unresectable c an be considered for chemoembolization. Liver transplantation should b e reserved for selected patients with cirrhotic liver disease who have tumors (diameter, <5 cm) in the context of neoadjuvant protocols.