Resection for large hepatocellular carcinoma (HCC) is challenging. However, the role of multimodality nonsurgical therapy for HCC greater than 10 cm is unclear.
In this study, doctors from Taiwan investigated 131 HCC patients with tumors larger than 10 cm, between 1990 and 2001.
The 56 patients in group A underwent hepatectomy, while the 75 patients in group B underwent nonsurgical multidisciplinary therapy. The nonsurgical therapy included hepatic arterial infusion, transcatheter arterial embolization, and percutaneous acetic acid injection.
|Younger patients had a higher prevalence of hepatitis B surface antigen positivity.|
|Journal of the American College of Surgeons|
The team determined that the patients in group B were older and had lower serum albumin levels. This group also contained more patients with liver cirrhosis and great vessel invasion.
The doctors found that the median survival of patients in group A was 17 months, compared with 7 months for patients in group B.
However, 1-, 3-, and 5-year survival rates for group B patients who underwent 3 or more treatment sessions were not significantly worse than those for group A.
The team found that patients in group A had 38% and 72% recurrence rates at 6 and 12 months, respectively. They also had a significantly higher frequency of overall extrahepatic recurrence.
They also determined that 3 of 35 group B patients younger than 60 years had tumor shrinkage after nonsurgical treatment, compared with 17 of 40 patients over 60.
The younger patients tended to have a higher prevalence of hepatitis B surface antigen positivity and infiltrating tumor growth pattern, compared with older patients.
Dr King-Tong Mok's team concluded, "Our study suggests that the advantage of hepatic resection in patients with huge HCC is marginal".
"An effective adjuvant therapy is needed to improve outcomes after hepatic resection".
"The experience in using nonsurgical treatment shows that the result is poor in young patients compared with that in elderly patients".