EARLY DETECTION OF RECURRENT HEPATOCELLULAR-CARCINOMA

Background/Aims: Early detection and treatment of recurrent hepatocell ular carcinoma (HCC) are keys to patient survival after hepatic resect ion. In. attempts at early detection, rue mahe use of the alpha-fetopr otein (AFP) test every month and abdominal ultrasound (US) and compute d tomography (CT) are carried out every three months after hepatectomy . The objective of the present study was to evaluate the most appropri ate interval for follow-up re-examinations after resection for HCC. Pa tients and Methods: Eighty-five patients with recurrent HCC were divid ed into two groups according to the state of the tumor when recurrence was detected: Group I (n=70); tumor size less than or equal to 2.0cm, and group II (n=15); tumor size greater than or equal to 2.1cm. Clini copathological comparisons were made between the true groups. Results: AFP positivity in. group I was significantly lower than group II at t he time of recurrence. Rates of extrahepatic intra-abdominal recurrenc es, i.e. recurrence at the surgical stump and in. the abdominal cavity and lymph nodes around the liver, were more frequent in, group II tha n in group I (47% vs 4%; p < 0.001). The average tumor size was larger in. 10 patients with extrahepatic intra-abdominal recurrence than in 75 patients with intrahepatic recurrence (3.4+/-2.0 vs 1.6+/-0.6 cm; p < 0.0001). There was a statistically significant difference regarding the histological grade of initial HCC between the two patterns of rec urrence. Conclusions: Measurements of AFP were seen to have limited va lue for detecting recurrence, at an. early stage. Close postoperative follow-up, including bedside US in the outpatient clinic, should be ca rried out when the initial HCC is histologically less differentiated H CC.