CLINICAL MANAGEMENT OF RECURRENT HEPATOCELLULAR-CARCINOMA

Objective The aim of this study was to evaluate the long-term benefits of the aggressive treatments with resection or transarterial chemoemb olization (TACE) for recurrent hepatocellular carcinoma (HCC). Summary Background Data Primary HCC is one of the most fatal malignancies in Taiwan. The result of resection for HCC remains unsatisfactory, primar ily due to the high recurrence rate. To improve surgical results, recu rrent HCC must be treated with aggressive resection or TACE, Methods T he authors evaluated the results of repeated hepatic resection among 2 5 patients with recurrent HCC and of TACE among 12 patients with resec table recurrent HCC, The outcomes of an additional 64 patients with un resectabie recurrent HCC were also evaluated. Results During the follo w-up period from 2-112 months, 52% (13/25) of patients receiving repea t resection (group 1) were alive, whereas 42% (5/12) of patients recei ving TACE (group 2) were alive. No perioperative deaths within 30 days after surgery occurred in the repeated resection group, The cumulativ e survival rates at 1, 2, 3, and 5 years after the first operation wer e 92%, 84%, 71.6%, and 65.1% in group 1 and 83.3%, 75%, 75%, and 22.5% in group 2. The survival rates at 6 months and at 1, 2, and 3 years a fter recurrence were 92%, 72%, 64%, and 44.8% in group 1 and 83.3%, 75 %, 66.7%, and 48% in group 2. The survival of patients with unresectab le recurrent HCC was much worse: 1-, 2-, 3-, and 5-year survival after surgery was 57.8%, 29.8%, 15.5%, and 0%; and 6-month and 1-, 2-, and 3-year survival after recurrence was 46.5%, 29.2%, 12.5% and 7.8%. Con clusions More aggressive treatment with repeated hepatic resection can prolong survival time after recurrence of HCC in selected patients. H owever, TACE can also achieve good results although it is not thought of as curative.