A total of 850 patients with hepatocellular carcinoma seen during the last 8 years were analyzed retrospectively for survival in relation to treatment and disease stage. A new staging scheme based on tumor size, ascites, jaundice and serum albumin was used. Clearly, the prognosis depended on disease stage. The median survival of 229 patients who received no specific treatment was 1.6 months, 0.7 month for Stage III patients, 2.0 months for Stage II, and 8.3 months for Stage I. The median survival of Stage I patients who had hepatic resection (n = 115) was 25.6 months and Stage II patients with resection (n = 42) was 12.2 months. In patients who had a small cancer (less than or equal to 25% of liver area in size) the median survival was 29.0 months. Survival of the surgically treated patients, which represented a highly selected group, was better than that of medically treated patients of a comparable stage. Median survival of Stage I medically treated patients (n = 124) was 9.4 months, for Stage II (n = 290) 3.5 months, and for Stage III (n = 50) 1.6 months. Medical treatment prolonged survival in Stage II and III patients, but not in Stage I. Transcatheter arterial embolization gave a better survival compared with chemotherapy, whether intra-arterial bolus administration of mitomycin C, systemic mitomycin C, or oral/rectal tegafur, in Stage II. Among various chemotherapeutic modalities, intra-arterial bolus injection was superior to systemic chemotherapy in survival in Stage II. In Stage III, chemotherapy improved survival as compared with no specific treatment. The major causes of death were hepatic failure and gastrointestinal bleeding, probably due to the coexistent advanced cirrhosis. These results in survival are much improved over the past reports, and the differences are probably a result of earlier diagnosis and frequent hepatic resections.

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Clinical features of hepatocellular carcinoma (HCC) with normal serum alpha-fetoprotein (AFP) levels were compared with those of AFP-positive cases. A total of 606 patients were divided into four groups based on their serum AFP levels at the time of diagnosis: group 1 (less than or equal to 20 ng/ml, N = 125), group 2 (20-1000 g/ml, N = 256), group 3 (1000-10000 ng/ml, N = 149), and group 4 (greater than 10000 ng/ml, N = 76). Increasing prevalence of group 1 patients and decreasing prevalence of group 4 were noted during the last 9 years. The proportion of hepatitis B virus-positive cases was significantly lower in group 1 than in group 4. The serum glutamic oxaloacetic transaminase/serum glutamic pyruvic transaminase ratio was found to be significantly higher in group 4 than in group 1 regardless of the size of the tumors. The survival rates were compared among the four groups in size matched cases since the size of the tumor significantly influenced their prognosis. The median survival in relatively small HCC patients (less than or equal to 5 cm in diameter, N = 199) were 24.6 months for group 1, 20.6 months for group 2, and 13.7 months for group 3 patients; and those in large HCC (greater than 50% in the proportion of the tumor area, N = 200) were 15.1 months for group 1, 6.3 months for group 2, 5.8 months for group 3, and 5.2 months for group 4. Thus, serum AFP values at the time of presentation are not only of diagnostic value, but also of prognostic significance in patients with HCC.

To assess whether ultrasound-guided percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small hepatocellular carcinoma (HCC), 60 patients with one to four HCCs smaller than 3 cm were entered onto a randomized controlled trial. Thirty-one and 29 patients, respectively, were treated by percutaneous acetic acid injection using 50% acetic acid or by percutaneous ethanol injection using absolute ethanol. There were no significant differences in age, sex ratio, Child-Pugh class, size of tumors, or number of tumors between the two groups. When there was no evidence of viable HCC from biopsy, plain and helical dynamic computed tomography, or angiography, the treatment was considered successful and was discontinued. All original tumors were treated successfully by either therapy. However, 8% of 38 tumors treated with percutaneous acetic acid injection and 37% of 35 tumors treated with percutaneous ethanol injection developed a local recurrence (P F .001) during the follow-up periods of 29 ؎ 8 months and 23 ؎ 10 months, respectively. The 1-and 2-year survival rates were 100% and 92% in percutaneous acetic acid injection and 83% and 63% in percutaneous ethanol injection (P ‫؍‬ .0017). A multivariate analysis of prognostic factors revealed that treatment was an independent predictor of survival. The risk ratio of percutaneous acetic acid injection versus percutaneous ethanol injection was 0.120 (range, 0.027-0.528; P ‫؍‬ .0050). In conclusion, percutaneous acetic acid injection is superior to percutaneous ethanol injection in the treatment of small HCC. (HEPATOLOGY 1998;27:67-72.)Hepatocelluar carcinoma (HCC) is one of the major malignancies with poor prognosis in eastern Asia, especially China, Japan, Taiwan, Singapore, and Korea, as well as Sub-Saharan Africa 1 ; the estimated incidence is approximately 1,250,000 deaths per year worldwide. 2 The early detection strategies for HCC have increased the number of small resectable HCCs in regions where they are endemic. [3][4][5] The survival rates reported after resection have improved in the last decade, mainly because of the increasingly smaller sizes of resected tumors. 4-9 Some surgical teams have thus achieved a 50% 5-year rate of survival in patients with small, asymptomatic HCCs. 5,6 However, resection is possible in a small proportion of patients because of the underlying advanced cirrhosis. Orthotopic liver transplantation is also an effective treatment for small, unresectable HCCs, but potential recipients far outnumber donors.Such difficulty in the management of HCC prompted the development of other potentially curative therapeutic modalities such as transcatheter hepatic arterial embolization (TAE) 13,14 and ultrasound (US)-guided percutaneous injection of materials that will kill cancer cells. [15][16][17][18][19][20][21][22] The latter is indicated for both hypervascular and hypovascular HCCs, whereas TAE is only for hypervascular HCCs; small HCCs are frequently hypovascular. Percutaneous ethanol injection (PEI) is...

Prognosis of 600 consecutive patients with hepatocellular carcinoma was analyzed in relation to treatment. They were divided into three stages based on four parameters of advanced disease: ascites, tumor greater than 50% of the two-dimensional size of the liver, serum albumin below 3 gm per dl, and serum bilirubin above 3 mg per dl. Stage I had none of these signs; Stage I1 one or two signs, and Stage 111 three or all signs. Of 600 patients, 98 had resection, 333 had nonsurgical treatment (1 58 treated by intraarterial chemotherapy, 94 systemic chemotherapy, 77 transcatheter embolization, and 4 others) and 169 no treatment.The median survival of untreated patients was only 1.6 months from diagnosis, and no untreated Stage I11 patient lived more than 3 months; there was a median survival of 0.7 month. Surgically treated patients lived significantly longer than nonsurgical patients of comparable stages; median survival was 19.6 months in the former and 2.8 months in the latter. Whereas Stage I patients did fairly well without treatment, chemotherapy significantly prolonged survival of patients of Stages I1 and 111. These results suggest that early diagnosis and hepatic resection improve prognosis in patients with hepatocellular carcinoma in the areas where this cancer frequently emerges unicentrically. In view of the generally poor prognosis, liver transplantation is recommended when resection is not possible or indicated, and before extrahepatic metastasis occurs. Hepatocellular carcinoma (HCC) is the most common form of primary hepatic carcinoma and represents one of the most malignant solid tumors in terms of prognosis. It is followed in decreasing frequency by cholangiocarcinoma, mixed hepatocholangiocarcinoma, hepatoblastoma, angiosarcoma, etc. (1). There are regional differences in the clinical presentation and natural history. Advanced cirrhosis is uncommon, and the liver is often free of cirrhotic changes in South African blacks as contrasted by more frequent cirrhosis in other parts of the world where patients may present as a case of cirrhosis and HCC emerges during the follow-up (2). Despite these differences, the basic clinical features and generally poor prognosis are the same regardless of race and place. In this study, we evaluated the prognosis of patients with HCC seen and treated at major hospitals in Japan. These findings should be applicable to other parts of the world. PATIENTS AND METHODSSix hundred consecutive patients with unequivocal HCC who were admitted and followed at the First DeAddress reprint requests to: Kunio Okuda, M