Hepatic resection of hepatocellular carcinoma (HCC) should not be contraindicated in patients with multiple tumors or portal hypertension (PHT), according to a report from Japan in the June issue of Gastroenterology.
“Surgical indications recommended by the AASLD (American Association for the Study of Liver Disease) guideline and BCLC (Barcelona Clinic Liver Cancer) staging system may be too strict (resection is recommended only for patients with a single tumor without PHT), given that resection has offered the 5-year survival rate of close to 60% for Child-Pugh class A patients with multiple tumors and/or PHT,” Dr. Norihiro Kokudo from the University of Tokyo told Reuters Health.
Dr. Kokudo and colleagues assessed the therapeutic value of liver resection for multiple HCC tumors and for HCC with PHT and reevaluated the current treatment algorithms for HCC, which were constructed on the basis of data obtained mainly in Western countries.
Although long-term overall survival was lower in patients with multiple tumors than in patients with single tumors, the authors report, patients with multiple tumors had 5-year survival rates of 58% among those with Child-Pugh class A cirrhosis.
Long-term overall survival was also poorer in Child-Pugh class A patients with PHT (56% at 5 years) than in patients without PHT (71% at 5 years), the report indicates.
Nonetheless, “the overall survival of these patients exceeded the currently accepted limit for curative treatment of HCC (a 5-year overall survival of 50%) and compared favorably with previous results after resection (24%-60% for patients with multiple HCCs and 17%-50% for those with PHT),” the investigators explain.
In multivariate analyses, multiple tumors and PHT did not significantly predict overall survival, although multiple tumors independently increased the risk of recurrence.
Child-Pugh class B strongly predicted poor overall survival after resection, the researchers note.
Resection after recurrence also improved overall survival in patients with multiple tumors and in those with PHT, as well as in patients with single tumors and in those without PHT, the investigators say.
“We are planning to conduct a multicenter randomized controlled trial to compare therapeutic efficacy of resection and ablation for HCC, including Child-Pugh class B patients,” Dr. Kokudo said.
“We must admit that Child-Pugh class B patients with multiple HCCs and/or PHT may not be good candidates for liver resection,” Dr. Kokudo added. “However, resection may still be valuable even for Child-Pugh class B patients depending on the tumor characteristics (e.g., superficially located tumor or multiple tumors in a same segment).”
Gastroenterology 2008:134:1908-1916.
Reviewed by Ramaz Mitaishvili, MD
