Hepatic resection versus transplantation for hepatocellular carcinoma

Many types of advanced liver disease are now treated by liver transplant. However, the role of liver transplant in the treatment of hepatocellular cancer has not yet been defined. Hepatocellular carcinoma, a malignant tumor of the liver, occurs most often in Africa and the Far East, and has a poor prognosis. Surgical excision of the tumor has been the only treatment found to be effective. Previous studies have reported a high rate of recurrence for hepatocellular cancer patients treated by transplant. However, a small number of patients have been cured by transplant. A study was undertaken to compare the 10-year outcome of patients who received a liver transplant (105 subjects) and those who underwent subtotal liver resection (76 subjects). The overall survival rate at one year was 71.1 percent for resection, and 65.7 percent for transplant; at two years, 55.0 percent, and 49 percent; at three years, 47.2 percent, and 39.2 percent; at four years 37.2 percent, and 35.6 percent; and, at five years 32.9 percent, and 35.6 percent. In both treatment groups survival correlated with tumor staging, a system for describing the extent of the spread of cancer. If the patient had liver cirrhosis (degenerative disease of the liver), survival after transplant was significantly better than after resection. Cancer recurrence rate was high in both groups; at 50 after resection, and 43 percent after transplant. A better than five year survival rate was achieved by 12 patients who underwent resection, and by 13 patients who received a liver transplant. Improvements in survival will probably come from advances in nonsurgical anti-cancer therapy given before and/or after surgical removal of the tumor. (Consumer Summary produced by Reliance Medical Information, Inc.)