Hepatocellular carcinoma: Surgical treatment and prognostic variables in 56 patients

BACKGROUND/AIMS: Partial hepatectomy (PH) or total hepatectomy and orthotop ic liver transplantation (OLT) may be curative in selected patients treated for hepatocellular carcinoma (HCC). The analysis of clinical series may he lp in the choice of the more appropriate treatment. METHODOLOGY: During the past 11 years, 40 patients with HCC were treated by PH and 16 patients underwent total hepatectomy and OLT. Selection criteria for transplantation were the liver function and the tumor resectability. RESULTS: The actuarial 1-, 3- and 5-year survival rates were 67%, 34% and 1 8%, respectively, after PH and 62%, 54% and 54% after OLT. The only prognos tic factor after PH was the tumor extension to a single or both lobes. Pati ents with associated cirrhosis had significantly more post-operative compli cations, but a comparable long-term survival. The proliferative cell nuclea r antigen labeling index (PCNA-LI), evaluated on tumoral tissue in 16 patie nts, showed that an index <30% indicates a better prognosis for HCC develop ing in non-cirrhotic Liver. CONCLUSIONS: For patients carefully pre-operatively evaluated, the presence of an associated cirrhosis does not seem to modify the long-term survival after PH, and OLT may offer more than 50% 5-year survival. A PCNA-LI <30% a ppears to be a good prognostic factor in patients without cirrhosis.