Surgical treatment of hepatocellular carcinoma and related basic research with special reference to recurrence and metastasis

Objective To summarize the progress of surgical treatment of hepatocellular carcinoma (HCC) and related basic research at the Liver Cancer Institute o f Shanghai Medical University in the recent years, with special reference t o recurrence and metastasis. Methods Published and unpublished update clinical and experimental data in the above-mentioned areas are summarized. Results Surgical resection has played an important role in improving progno sis of HCC, the 5-year survival were 63.4% for small HCC resection (n = 806 ), 39.6% for large HCC resection (n = 1061), 64.7% for cytoreduction (using hepatic artery cannulation and ligation) and sequential resection of initi ally unresectable HCC (n = 93), 56.0% for cytoreduction using transcatheter arterial chemoembolization (TACE) and followed by resection (n = 65), and 22.4% for hepatic resection with removal of tumor thrombi in portal vein (n = 103). Unfortunately, the 5-year recurrent rate after curative resection of HCC was up to 61.5%, which was mainly a result of intrahepatic "metastas is" and multicentric origin of HCC. Clinically, re-resection of subclinical recurrence yielded 56% of 5-year survival (n = 202); prevention of recurre nce by transcatheter arterial chemoembolization (TACE) + Interferon, or LAK /IL-2 therapy have decreased 3-year recurrent rate from 33% to 11% - 18%. I n experimental aspect, metastatic human HCC model in nude mice (LCI-D20) an d HCC cell line with metastatic potential (MHCC97) have been established; s tudies on HCC invasiveness in the molecular level revealed similar results that reported in other solid cancers, and small HCC showed slightly better biological characteristics as compared with large HCC; microvessel density (MVD) that reflecting angiogenesis adversely correlated with 5-year surviva l of small HCC; experimental interventions using antisense H-ras, bispecifi c antibody, BB94, as well as anti-angiogenic agents (TNP470, suramin, CAI, heparin, antisense VEGF, etc.) have been demonstrated to inhibit tumor grow th and lung metastasis in nude mice model. Conclusions Recurrence and metastasis are the major obstacle to further imp rove prognosis of HCC, studies should be conducted both in clinical and exp erimental aspects, "HCC invasiveness" will be the major target to be studie d, particularly in the molecular level, and anti-angiogenesis will be one o f the important approach.