HEPATOCELLULAR-CARCINOMA IN THE CAUDATE LOBE - EARLY DIAGNOSIS AND ACTIVE TREATMENT MAY RESULT IN LONG-TERM SURVIVAL

Hepatocellular carcinoma (HCC) in the caudate lobe is rare and the pro gnosis of patients with HCC in the caudate lobe has been reported to b e poor. Resection far HCC in the caudate lobe has carried a higher rat e of surgical risk and early recurrence. The effect of transcatheter a rterial embolization (TAE) in treating HCC in the caudate lobe remains unknown. With the wide application of modern diagnostic modalities, w e can now detect HCC at an earlier stage for active treatment (surgery or TAE). The aim of the present study was to analyse the effect of di fferent treatments for HCC in the caudate lobe. From 1985 to 1994, 15 patients with HCC in the caudate lobe mere retrospectively studied. An other 264 consecutive patients with newly diagnosed HCC created by TAE were selected as the control group. Two patients underwent surgical r esection and survived well without recurrence after 43 and 136 months, respectively. Ten patients underwent TAE and their survival rate was similar to that of the 264; consecutively TAE-treated controls with HC C not in the caudate lobe (P = 0.19). The 1, 3 and 5 year survival rat es for TAE-treated patients in the caudate lobe were 67.7, 31.1 and 12 .6%, respectively, while in controls these figures were 53.0, 18.4 and 9.1%, respectively Two of the three patients receiving supportive tre atment died within 1 month after diagnosis. Those patients having a sm aller solitary tumour without intrahepatic metastasis tended to surviv e longer. In conclusion, HCC in the caudate lobe does not always indic ate a poor prognosis so long as early detection and active treatment ( surgery or TAE) ars available. Transcatheter arterial embolization may act as an alternative treatment modality for patients with HCC in the caudate lobe.