[Treatment of liver cancer: current status and future prospectives].
The most common liver cancers are hepatocellular carcinoma (HCC), cholangiocellular carcinoma (CCC), and metastatic colorectal cancer. In HCC patients, the extent of the surgical resection is limited due to the functional status of the underlying cirrhotic liver. Limited resection, transarterial catheter embolization, ethanol injection, and microwave coagulation have been applied to treat the patients with liver hypofunction; however, the intrahepatic recurrence rate was relatively high in those patients. Therefore, liver transplantation is the only radical treatment to remove HCC and cirrhotic livers with viral infections. Recent advances in anti-viral agents promise to improve the outcome after liver transplantation in patients with HCC. On the other hand, CCC is outside the indications for liver transplantation because of the broad extension of lymph node and nerve plexus. In liver metastasis from colorectal cancer, overall survival is not greatly improved, although arterial chemotherapy reduces mortality related to liver metastasis. Surgical resection including repeated hepatectomy indicates better survival in patients with liver metastases. In the future, both CCC and metastatic liver cancer could be candidates for gene therapy. For the 21 century, a new therapeutic strategy incorporating clinical evidence, molecular biology, and organ replacement needs to be established for the treatment of liver cancer.
Dept. of Surgery II, Nagasaki University School of Medicine, Japan.
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Kamohara
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Kanematsu
D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000601:surgery*; D019317:Evidence-Based Medicine; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D015996:Survival Rate