title: Hepatocellular carcinoma: multimodality management.
abstract: BACKGROUND
  Hepatocellular carcinoma is one of the most common tumors worldwide. Surgical resection has been the standard treatment but can only be applied to a small percentage of patients. In recent years, several other treatment options, including ablative procedures and transplantation, have been used in patients with hepatocellular carcinoma.
  
  
  METHODS
  For 6 years, 110 patients with hepatocellular carcinoma were managed at the Medical College of Wisconsin. Fifty-five patients received only chemotherapy (n = 5) or palliative treatment (n = 50) because of advanced cirrhosis (P <.03) or tumor. Thirty-one patients had tumor ablation with percutaneous ethanol injection, cryoablation, radiofrequency ablation, or arterial chemoembolization. Twenty-eight patients underwent surgical resection (n = 18) or hepatic transplantation (n = 10). Relatively more patients (38%; P <.001) were treated with ablation in the second period of the study (1998-2000).
  
  
  RESULTS
  Thirty-day mortality was 3% with ablation and 0% with resection. Median survival was 6 months with no treatment, 27 months with ablation (P <.001), and 35 months with resection (P <.001). Patients who underwent liver transplantation had the longest median survival (53 months). A multivariate analysis suggested that treatment modality (ablation or resection; P <.001) and Child-Pugh classification (P <.01) were the most important factors predicting outcome.
  
  
  CONCLUSIONS
  This study suggests that treatment of hepatocellular carcinoma requires multidisciplinary expertise and that ablation and operation can be performed safely. Outcome is influenced most by treatment modality and Child-Pugh classification. Patients in Child-Pugh classes A and B should be treated with ablation, surgical resection, or liver transplantation.
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, 53226, USA.
authors.forename: K K
authors.initials: KK
authors.lastname: Christians
authors.forename: H A
authors.initials: HA
authors.lastname: Pitt
authors.forename: W S
authors.initials: WS
authors.lastname: Rilling
authors.forename: J
authors.initials: J
authors.lastname: Franco
authors.forename: F A
authors.initials: FA
authors.lastname: Quiroz
authors.forename: M B
authors.initials: MB
authors.lastname: Adams
authors.forename: J R
authors.initials: JR
authors.lastname: Wallace
authors.forename: E J
authors.initials: EJ
authors.lastname: Quebbeman
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D017679:Cryotherapy; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D000078702:Radiofrequency Therapy
chemical_list: D000431:Ethanol