The surgical removal of cancer is a feasible first-line therapy for persons who have relatively small sized hepatocellular carcinoma of the liver in addition to hepatitis-associated cirrhosis of the liver, according to Chinese researchers. This finding is an important one in the treatment of persons who have both liver cancer and cirrhosis, as any liver damage caused by cirrhosis can adversely affect treatment outcomes.
Primary cancer of the liver is characterized by cancer cells that begin to grow in the liver, the largest organ in the human body. These cancer cells can then grow in size and can also spread to the veins or arteries of the liver and/or to other parts of the body (called advanced or metastatic disease). The most common type of primary liver cancer is called hepatocellular carcinoma. Treatment of primary cancer of the liver depends on many factors including the size and stage of disease (extent of disease at diagnosis). When possible, the cancer is completely surgically removed from the liver (called surgical resection), offering a chance for cure. However, even when all visible cancer is removed, there is a risk that a small undetectable amount of cancer cells remain. These cancer cells can then multiply until they are detectable once again, causing what is called a recurrence (return or relapse) of the cancer. The outcome of surgery depends on many factors, including the size and stage of the cancer, whether there are residual cancer cells remaining after surgery, and whether the liver is damaged by other diseases such as hepatitis or hepatitis-related cirrhosis. Recently, researchers from Hong Kong reported the results of their study comparing the outcomes of surgical resection in persons with hepatocellular carcinoma who had versus those who did not have cirrhosis.
The researchers evaluated 146 persons with hepatocellular carcinoma who had hepatitis B infection and hepatitis B-related cirrhosis and 155 persons with hepatocellular carcinoma who had hepatitis B infection but did not have cirrhosis. All patients underwent surgical resection to remove the cancer, and the outcomes from the 2 groups were compared. After 5 years, the overall survival rate was 44%, and the cause of the majority of deaths was recurrence of the cancer. Importantly, the outcome of surgical resection of smaller cancers in persons with cirrhosis was similar to that of surgical resection in persons who did not have cirrhosis. The outcome was poor in persons whose hepatitis B infection was active at the time of the surgery.
These findings suggest that surgical resection is an option for the first-line treatment of persons who have cirrhosis and relatively small size hepatocellular carcinoma, but is less effective for those with active hepatitis B infection. Further studies comparing the benefits of surgical resection and liver transplantation in these patients are needed. Persons who have hepatocellular carcinoma with or without cirrhosis may wish to talk with their doctor about the risks and benefits of participating in a clinical trial in which surgical resection or liver transplantation is being studied.
(Journal of Clinical Oncology, Vol 18, No 5, pp 1094-1101, 2000)