Prognostic factors after hepatectomy for hepatocellular carcinomas: a univariate and multivariate analysis

Article Abstract:

Liver cancer is especially common in Japan. Hepatocellular carcinoma is the third most common malignancy among Japanese men, and fifth among Japanese women. The treatment is surgical removal of much of the liver; the patient cannot be cured of his cancer, however, if he dies because too much of his liver was removed. The problem is exacerbated by the fact that 80 percent of liver cancer patients also have cirrhosis and therefore have impaired liver function to start with. New non-surgical techniques are being developed; therefore, a method must be devised to determine which patients have the best chances for successful surgery and which are best considered candidates for alternative treatments. An analysis of 295 patients undergoing surgical resection of the liver was performed to identify factors that correlated with improved survival. Factors contributing to survival include the absence of clots in the tumor, no metastatic spread within the liver, and a roughly 14 percent retention of indocyanine green dye at 15 minutes. (The retention of indocyanine dye is a test of liver function; patients with greater retention cannot, in general, undergo the resection of a large hunk of liver.) While it is to be preferred that the tumor be less than five centimeters in diameter, this is not a determining factor. Metastatic spread of the tumor may be treated surgically if the spread is limited to the neighborhood of the primary tumor. For patients who meet these criteria, the five-year survival rate for liver cancer is 78 percent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Hepatoma, Hepatocellular carcinoma

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Growth and spread of hepatocellular carcinoma: a review of 240 consecutive autopsy cases

Article Abstract:

Thanks to advances in medical imaging techniques, surgical specimens of hepatocellular carcinoma (liver cancer) are detected at earlier stages. Older methods of classifying the gross appearance of liver cancer were based upon more advanced cancers, and are no longer adequate. Based upon surgical specimens, the authors previously proposed a new method for classifying liver cancer based upon gross appearance. This new classification method has been applied to autopsy specimens from 240 cases to clarify the growth and spread of hepatocellular carcinoma. The classification scheme is based on the three major groups first defined by H. Eggel 90 years ago: nodular, massive, and diffuse. The authors add three subtypes to the nodular classification: type 1, single nodular; type 2, single nodular with extranodular growth; and type 3, contiguous multinodular. The authors correlated the mode of growth and spread of cancer with the different types. Type 1 was more likely to occur in cirrhotic liver, and type 2 had a high frequency of causing thrombus in the portal vein. Type 3 occurred in less cirrhotic liver and was more invasive. Type 3 liver cancer had a high frequency of metastatic spread to the blood and lymphatic system. The observations confirm that appearance, as well as size, of gross tumor specimens is an important factor when trying to understand the growth and spread of liver cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression

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Clinical and radiologic assessments of the results of hepatectomy for small hepatocellular carcinoma and therapeutic arterial embolization for postoperative recurrence

Article Abstract:

The advent of modern medical imaging techniques has improved the ability to diagnose small hepatocellular carcinoma (s-HCC), a cancer of the liver. With rapid, reliable diagnosis, more patients are being treated surgically for this tumor. Patients with s-HCC were followed-up postoperatively, for periods ranging from nine months to more than nine years, to determine the natural history of the disease and to evaluate the effectiveness of introducing an arterial embolus, or a block in an artery, as treatment for recurring tumors in the liver. Of the 123 patients followed, 54.2 percent had a recurrence of s-HCC tumor in their liver an average of 14.9 months after surgery. Of the 48 recurrences diagnosed by imaging techniques, 12 were negative for alpha-fetoprotein, which is usually regarded as a blood-borne marker for liver disease. This demonstrates the improved reliability of the imaging techniques. Sixteen patients were lost to complete follow-up. Of the remaining patients with s-HCC, the 5-year survival rate was 48.9 percent for those without tumor recurrence and 11.0 percent for patients with recurrence. Embolization treatment of the recurring tumors seemed to provide some benefit; for patients with recurring liver tumors, the survival rate was 0 percent without embolization treatment and 14.9 percent among those who received the treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Liver

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