A multidisciplinary approach to hepatocellular carcinoma in patients with cirrhosis.
BACKGROUND
A multidisciplinary approach has been developed to evaluate and treat patients with cirrhosis and hepatocellular carcinoma (HCC).


METHODS
We evaluated 153 patients with cirrhosis and HCC. Fourteen patients with Child's A cirrhosis underwent resection. Transplantation was performed in 40 patients with HCC less than 5 cm (32 incidental, eight recognized preoperatively), in six patients with HCC 5 cm or greater not recognized preoperatively, and in 11 patients with recognized HCC 5 cm or greater; the latter 11 underwent transplantation in a multimodality protocol using pretransplant chemoembolization and intraoperative and postoperative chemotherapy.


RESULTS
Among the 14 patients who underwent resection, the three-year survival rate was 39 percent. Among the 40 patients with HCC less than 5 cm who underwent transplantation, no tumor recurrence was observed. Among the six with HCC 5 cm or greater unrecognized preoperatively, three had tumor recurrence. Among the 11 with HCC 5 cm or greater enrolled in the protocol, there were no deaths and one recurrence at a mean of 433 days follow-up. The four-year survival rate for all patients who underwent transplantation with HCC was 56 percent (66 percent excluding the six patients with unrecognized HCC 5 cm or larger).


CONCLUSIONS
Hepatocellular carcinoma less than 5 cm in patients with cirrhosis (Child's B or C) is an indication for hepatic transplantation. Hepatocellular carcinoma less than 5 cm in patients with cirrhosis (Child's A), although resectable, may in some cases be better treated by hepatic transplantation. Transplantation for HCC 5 cm or greater within a multimodality protocol has yielded excellent results at two years.
Schwartz
M E
ME
Department of Surgery, Mount Sinai Medical Center, New York, NY 10029, USA.
Sung
M
M
Mor
E
E
Fisher
A
A
Popescu
I
I
Fiel
I
I
Sheiner
P
P
Emre
S
S
Guy
S
S
Miller
C M
CM
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007430:Intraoperative Care; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D010348:Patient Care Team; D011182:Postoperative Care; D011300:Preoperative Care; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed