HEPATOCELLULAR-CARCINOMA - EFFICACY OF TRANSCATHETER OILY CHEMOEMBOLIZATION IN RELATION TO MACROSCOPIC AND MICROSCOPIC PATTERNS OF TUMOR-GROWTH AMONG 100 PATIENTS WITH PARTIAL-HEPATECTOMY

Purpose: To evaluate the efficacy of transcatheter oily chemoembolizat ion (TOCE) for hepatocellular carcinoma (HCC) on the basis of microsco pic and macroscopic findings postembolization. Methods: HCCs ranging i n size from 0.5 to 13 cm (mean 3.6 cm) were obtained from partial hepa tectomies of 100 consecutive patients who had undergone TOCE between 2 0 and 246 days (mean 59.5 days) prior to surgery. The efficacy of TOCE was assessed on the basis of the necrotic to live cell ratio of the t umors. The microscopic pattern of tumor growth was grouped into expand ing type (complete capsule formation) and replacing type (incomplete o r no capsule). There were five types of macroscopic groupings: single nodule, single nodule with extranodular growth (SNE), contiguous and n oncontiguous multinodular, and massive growth type. Results: Among 79 cases with the expanding type, 29 (37%) had 100% HCC necrosis, but non e with 100% necrosis were in the replacing type. By macroscopic groupi ng, the efficacy of TOCE decreased from the single nodule type (50% of patients had 100% necrosis) to the SNE type (21%), and the other type s (9%). Conclusion: TOCE appears to be most efficacious for HCC with t he expanding growth pattern and HCC forming single nodules. Poor resul ts are to be expected in HCC of replacing growth type and multinodular or massive growth types.