Hepatocellular carcinoma: comparison between liver transplantation, resective surgery, ethanol injection, and chemoembolization.
Between January 1989 and June 1997, 533 patients (423 male, 110 female, mean age 61 years, range 22-89 years) with hepatocellular carcinoma (HCC) were observed at our center. We report on 419 patients retrospectively compared for different treatments: liver transplantation (LT; 55 patients), resective surgery (RS; 41 patients), transarterial chemoembolization (TACE; 171 patients) and percutaneous ethanol injection (PEI; 152 patients). The 3- and 5-year actuarial survival rates were, respectively, 72% and 68% for LT, 64 and 44% for RS, 54 and 36% for PEI, and 32 and 22% for TACE. Survival curves were compared for sex, age, tumor characteristics, alphafetoprotein level, Child class, and etiology of cirrhosis. All patient-related characteristics examined (sex, age) are not significantly related to patient survival. Tumor-related variables and associated liver disease variables significantly conditioned survival in relation to different treatments. LT seems to be the treatment of choice for monofocal HCC less then 5 cm in diameter and in selected cases of plurifocal HCC.
Department of Surgery and Abdominal Organ Transplantation, Niguarda Hospital, Milan, Italy.
G
G
Colella
R
R
Bottelli
L
L
De Carlis
C V
CV
Sansalone
G F
GF
Rondinara
A
A
Alberti
L S
LS
Belli
F
F
Gelosa
G M
GM
Iamoni
A
A
Rampoldi
A
A
De Gasperi
A
A
Corti
E
E
Mazza
P
P
Aseni
A
A
Meroni
A O
AO
Slim
M
M
Finzi
F
F
Di Benedetto
F
F
Manochehri
M L
ML
Follini
G
G
Ideo
D
D
Forti
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007267:Injections; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate
D000431:Ethanol