Treatment of fibrolamellar hepatoma with subtotal hepatectomy or transplantation

Abstract

Fibrolamellar hepatoma (FL-HCC) is an uncommon variant previously reported4-6 ), less than 100 such cases can be found in the literature. 2,3,[7][8][9][10][11][12][13][14][15][16][17] In our series, we have compared the of hepatocellular carcinoma (HCC), distinguished by histopathological features suggesting greater differentiation than survival of patients with FL-HCC with that of patients with conventional HCC who were treated by the same team over conventional HCC. However, the optimal treatment and the prognosis of FL-HCC have been controversial. Follow-up a 27-year period. studies are available from 1 year to 27 years, after 41 patients with FL-HCC were treated with partial hepatectomy (PHx) PATIENTS AND METHODS (28 patients) or liver transplantation (13 patients). In thisCase Material retrospective study, the effect on outcome was determined for the pTNM stage and other prognostic factors routinely Between 1968 and 1995, 477 (range, 9-66; median, 25) (Fig. 1). The median follow-up was 58 tumor-free survival than those with negative nodes (P õ .015).{ 9.3 months. Patient survival was most adversely affected by the presence of vascular invasion (P õ .05). FL-HCC is an indolently grow- Clinicopathological Characteristicsing tumor of the liver, which usually was diagnosed in our patients at a stage too advanced for effective surgical treatmentThe pathology reports and operative findings were used to deterof most conventional HCC. Nevertheless, long-term survival mine: the principal tumor size, number of lesions, lobar distribufrequently was achieved with aggressive surgical treatment. tion, vascular and lymphatic tumor extension, surgical margins, When a subtotal hepatectomy could not be performed, total distant metastases, and the presence or absence of associated cirrhosis. When available, the tumor markers were recorded as well as hepatectomy (THx) with liver transplantation was a valuable the virus markers (hepatitis C virus, hepatitis B virus).

Liver transplantation for hepatocellular carcinoma in patients without underlying liver disease: A systematic review

“…All of these factors have prognostic significance in cirrhotic patients with HCC undergoing OLT, 4,5,[7][8][9] as well as in cirrhotic and noncirrhotic patients treated by liver resection. 4,10,11 There are several reasons why we could not show these relationships. First, for non-FL-HCC, the outcome was poor for nearly all patients, with only 1 in 10 surviving 5 years.…”

Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

“…The results of the ELTR study (unpublished data, 2011) confirm these findings. These observations, along with the fact that (1) FL-HCC did not differ from other HCCs arising in a normal liver with respect to any variable (except for the tumor size and the Milan inclusion criteria) 39 and (2) the proliferative activities of these tumor variants (eg, as determined by immunohistochemistry for Ki-67) were also similar, 35,43,44 explain why HCC in normal livers and FL-HCC were deliberately pooled together in the ELTR study. This allowed a valuable statistical evaluation of the place of LT in the treatment of NC-HCC to be made.…”

“…Separate Note on FL-HCC [43][44][45][46][47][48][49][50] Because the analysis of the literature shows that NC-HCC and FL-HCC are still perceived differently on account of their different clinical presentations, courses, imaging results, and outcomes, some brief remarks about this tumor variant are made here.…”

“…48 The somewhat better results reported after hepatectomy versus LT can be explained by the more advanced tumor stages and immunosuppression in liver recipients, as shown in the transplant series from Hannover (8 patients), 48 Birmingham, UK (9 patients), 44 and Pittsburgh (13 patients). 43 For example, 90% of the Pittsburgh patients were determined to be stage IVA or IVB. The 5-year OS rates for 28 resection patients and 13 transplant patients were 88% and 36.3%, respectively; the 5-and 10-year DFS rates were 33% and 30.8%, respectively.…”

“…The 5-year survival rate after recurrence was 28%. 43 The 5-year OS rate of the partial hepatectomy series from the Memorial Sloan-Kettering Cancer Center (New York, NY), which included 28 patients, reached 56%. 48 There is some indication that adjuvant chemotherapy (a combination of 5-fluorouracil and interferon) may be useful and more applicable in these patients because they present with normal residual liver tissue.…”