title: Downstaging followed by resection plays a role in improving prognosis of unresectable hepatocellular carcinoma.
abstract: BACKGROUND
  Curable outcome of unresectable hepatocellular carcinoma (HCC) was seldom encountered in the past. This study was designed to assess the role of downstaging followed by resection (downstaging-resection) in the improvement of prognosis of unresectable HCC.
  
  
  METHODS
  During the period of 1958-2003, a total of 1085 patients were verified surgically to be unresectable. Of these patients, 139 received downstaging-resection, with a rate of 84.2% for coexisting cirrhosis and a median tumor diameter of 11.1 cm. Resection of the right lobe, hepatic hilum and bilateral cancer accounted for 97.8% of the patients. Downstaging including hepatic artery ligation (HAL)+hepatic artery chemo-infusion (HAI) was performed in 65.5% of the patients, HAL+HAI+radiotherapy/radioimmunotherapy in 29.5%, and HAL or HAI alone in 5.0%. Retrospective analysis was made of the survival of patients with unresectable HCC, downstaging-resection rate and treatment pattern.
  
  
  RESULTS
  In the 139 patients with downstaging-resection, the median interval between the first and second operation was 7.2 months and the 5-year survival rate calculated from the first operation was 48.7%. In the 1085 patients with unresectable HCC, their 5-year survival was 0% in the period of 1958-1973, 11.5% in the period of 1974-1988 and 19.3% in the period of 1989-2003. These figures were correlated with the increasing downstaging-resection rate from 0%, 9.0% to 15.6%, and the increasing percentage of triple or double combination treatment from 32.2%, 60.4% to 69.7%. The 5-year survival in triple treatment group was 24.9%, double treatment 15.2%, and single treatment only 10.9%, which was also correlated with the downstaging-resection rate of 34.6%, 16.2% and 1.8% respectively.
  
  
  CONCLUSIONS
  Downstaging-resection plays a role in improving prognosis of unresectable HCC. Triple and double treatments provide a higher downstaging-resection rate and may result in better prognosis.
authors.affiliation: Liver Cancer Institute of Fudan University, 136 Yi Xue Yuan Road, Zhongshan Hospital, Shanghai 200032, China. zytang@srcap.stc.sh.cn
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
authors.forename: Xin-Da
authors.initials: XD
authors.lastname: Zhou
authors.forename: Zeng-Chen
authors.initials: ZC
authors.lastname: Ma
authors.forename: Zhi-Quan
authors.initials: ZQ
authors.lastname: Wu
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.forename: Lun-Xiu
authors.initials: LX
authors.lastname: Qin
authors.forename: Yao
authors.initials: Y
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D004358:Drug Therapy; D005260:Female; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008026:Ligation; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016499:Radioimmunotherapy; D011878:Radiotherapy; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome