SUBCLINICAL HEPATOCELLULAR-CARCINOMA - AN ANALYSIS OF 391 PATIENTS

Subclinical hepatocellular carcinoma (SCHCC) is defined as HCC without obvious HCC symptoms and signs. During 1958-1991, 391 patients with S CHCC were analyzed. In the entire series, 1) 67.3% was detected by nat ural population screening using alpha-fetoprotein (AFP) serosurvey, wh ile the others were discovered by high-risk population screening or re gular health checkup using AFP and/or ultrasonography (US); 2) AFP > 2 0 mug/L was found in 77.6% of patients; 3) serum hepatitis B surface a ntigen (HBsAg) was positive in 68.9%; 4) associated liver cirrhosis oc curred in 89.1%; 5) the median tumor size was 5 cm, and small HCC (les s-than-or-equal-to 5 cm) amounted to 61.1%; 6) resection was done in 8 1.4%, and limited resection was performed in the majority (71.3%); 7) re-resection for subclinical recurrence was done in 44 patients; and 8 ) cytoreduction and sequential resection was carried out in 13 patient s with unresectable SCHCC. Comparison between SCHCC and clinical HCC ( n = 1,251) revealed higher resectability (81.4% vs. 46.8%), lower oper ative mortality (1.9% vs. 6.0%), and higher 5-year survival (entire se ries: 50.7% vs. 20.6%; resection: 60.5% vs. 36.8%). It is concluded th at the study of SCHCC has resulted in marked improvement of ultimate o utcome of HCC; screening in high-risk populations using AFP and/or US, limited resection, and re-resection for subclinical recurrence are so me of the key features.