title: [Influence of different treatment modalities on survival of patients with two -stage resection of unresectable hepatocellular carcinoma].
abstract: OBJECTIVE
  To study the therapeutic results of hepatic resection for shrunk hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and hepatic artery ligation and chemoembolization (HALCE) in patients with unresectable HCC, and compare the influence of the above different treatment modalities on the prognosis.
  
  
  METHODS
  Two hundred and four patients w ith pathologically proven HCC by two stage liver resection were classified into two groups: TACE group (n = 112) and HALEC group (n = 92). The patients in the TACE group received a total of 1-7 consecutive treatment courses (average, 2.4 +/- 1.2 courses). HALCE was done in 49 patients. HALCE alternating fractionated radiotherapy was employed in 7 patients and HALCE + targeting regional internal radiotherapy in 36. Shrunk tumors were surgically removed by two-stage operation in all the patients with unresectable HCC. Seven possible factors influencing the results of two-stage resection of HCC were studied.
  
  
  RESULTS
  All the patients were followed up to June, 1999. The 1-, 3-, 5-, and 7-year survival rates were 95.7%, 69.3%, 56.5% and 44.5% after the first TACE and HALCE, respectively and 88.5%, 64.9%, 51.9% and 38.3% after resection of the shrunk HCC, respectively. The 1-, 3-, 5- and 7-year survival rates were 94.1%, 64.7%, 51.2% and 40.8% respectively in the TACE group and 96.3%, 73.9%, 61.6% and 45.2% respectively in the HALCE group. There were no statistically differences between the survival rates in the TACE and HALCE groups. The extent of cirrhotic liver and percentage of tumor necrosis were of prognostic significance. In the TACE group, the extent of cirrhotic liver, the percentage of tumor necrosis and whether capsule of shrunk tumor was complete or in complete were of prognostic significance. In the HALCE group, however, the 7 factors were not found to be statistically significant for the prognosis.
  
  
  CONCLUSIONS
  Sequential resection should be done after cytoreduction of tumor for the patients with unresectable HCC, which might improve their survival. The extent of cirrhotic liver and the percentage of tumor necrosis after TACE or HALCE are the major factors affecting the survival of patients with two-stage operation.
authors.affiliation: Cancer Institute, Zhongshan Hospital, Medical Center, Fudan University, Shanghai 200032, China.
authors.forename: J
authors.initials: J
authors.lastname: Fan
authors.forename: Z
authors.initials: Z
authors.lastname: Wu
authors.forename: Z
authors.initials: Z
authors.lastname: Tang
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D002408:Catheters, Indwelling; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D011379:Prognosis; D015996:Survival Rate