Surgical indications for advanced hepatocellular carcinoma

Background/Aims: The aim of this study is to clarify the limitations of hep atectomy for advanced hepatocellular carcinoma. Methodology: Fifty-six patients with Stage 4 hepatocellular carcinoma were retrospectively studied, and the prognostic factors were both univariately and multivariately analyzed. The VI score, which was defined as the degree of portal vein invasion (VP) multiplied by the degree of intrahepatic metas tases (IM), was introduced as a new prognostic indicator. Results: A univariate analysis revealed the following significant variables : hypertension, esophageal varices, Child's classification B or C, a biliru bin value of over 1.0mg/dL, a albumin value of below 3.5g/dL, a GOT value o f over 100 IU/L, an AFP value of over 1000ng/mL, a history of tumor rupture , Stage 4B, a tumor size of over 5cm, VP3, IM3, and the VI score of no less than 6. A multivariate analysis demonstrated the following 4 variables to be independent prognostic indicators: a Stage of 4B, a VI score of no less than 6, a Child's classification of B or C, and a tumor size of over 5cm. F urthermore, no long-term survivors were found in patients with either Stage 4B HCC or a hepatocellular carcinoma having a VI score of more than 6. At the present time, either Stage 4B or a hepatocellular carcinoma having a VI score greater than or equal to 6 are considered to be factors which means the limitation of hepatectomy alone. Furthermore, an advanced hepatocellula r carcinoma with either poor liver function or a hepatocellular carcinoma w ith a size of over 5cm should be carefully evaluated before determining its appropriateness for hepatectomy. Conclusions: The VI score is therefore suggested to be a useful prognostic indicator for determining the surgical indications for advanced hepatocellu lar carcinomas.