THE INDICATIONS FOR TUMOR MASS REDUCTION SURGERY AND SUBSEQUENT MULTIDISCIPLINARY TREATMENTS IN STAGE-IV HEPATOCELLULAR-CARCINOMA

The indications for tumor-mass reduction surgery and subsequent immuno therapy in patients with stage IV hepatocellular carcinoma (HCC) were elucidated in this study. About 42% of the resected specimens from sta ge IV-A patients (n = 26) contained well-differentiated multicentrical ly occurring HCC, which was not found in any of the stage IV-B patient s (n = 9). The 2-year survival rate after reduction surgery was 49% fo r the stage IV-A patients and only 13% for the stage IV-B patients, wh ile 6 of the stage IV-A patients who survived for more than 2 years ha d no vascular invasion or distant organ metastases. Some of the stage IV patients maintained normal peripheral natural killer (NK) activity and were also able to tolerate surgical insults immunologically, provi ded that appropriate postoperative immunotherapy was given. Thus, stag e IV-A HCC has a greater possibility of containing slow-growing intrah epatic tumor clusters, and the removal of any rapidly growing tumors f rom among these should be undertaken by reduction surgery followed by subsequent multidisciplinary treatment for residual tumor cells, inclu ding appropriate immunotherapy.