Some persons who have liver cancer and cirrhosis, but good liver function, may be effectively treated by the surgical removal of the cancer rather than by a liver transplant, according to a recent report by Japanese and U.S. researchers. This finding is important because there is a shortage of donor livers available and some persons will not have the option of a transplant.
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. Hepatocellular carcinoma often develops in persons who have other serious liver diseases, such as hepatitis and/or cirrhosis.
The treatment of hepatocellular carcinoma depends on many factors including the size and stage of the cancer (extent of disease at diagnosis) and the overall health of the patient. When possible, the cancer is completely surgically removed from the liver (called surgical resection), offering a chance for cure. However, when the cancer is too advanced or large to be removed by surgery or the patient is too ill to undergo surgery, other therapies are needed. The only other chance for cure is a liver transplantation, a surgical procedure to remove the patient’s diseased liver and replace it with a healthy liver from a donor. Persons who have liver cancer with severe cirrhosis often have too much liver damage to undergo surgical resection of the cancer and are candidates for a liver transplant. Unfortunately, there is a shortage of donor livers and a transplant is not always an option. Because of this liver shortage, researchers recently studied whether surgical resection might still be an effective option for some persons with both liver cancer and cirrhosis.
Researchers from the United States and Japan compared the outcomes of 270 patients with hepatocellular carcinoma and cirrhosis who underwent a liver transplant with those of 294 patients with hepatocellular carcinoma and cirrhosis who underwent surgical resection. Overall, the group that underwent a transplant had more individuals with advanced cancer and more individuals with severe cirrhosis. Because of this discrepancy between the 2 groups, the researchers analyzed subsets of patients who were similar to each other. Outcomes were compared in 193 persons who had a surgical resection and 230 who had a transplant, all of whom had good liver function, no cancer in the blood vessels, no cancer in the lymph nodes, and no cancer that had spread to other parts of the body. Between these 2 subgroups there was no difference in survival times, with a 4-year survival rate of 60%. However, only 10% of those having a transplant had a recurrence (return) of the cancer, compared with 80% of those having a surgical resection.
From these findings, the researchers concluded that surgical resection can be an effective treatment approach for persons with hepatocellular carcinoma and cirrhosis that is well controlled and has not resulted in poor liver function. This means that transplants may be offered selectively to persons who have a recurrence of liver cancer and who have severe liver disease and poor liver function. It is important to note that this recommendation is due primarily to the shortage of donor livers available for transplant, as recurrences still appear to be fewer with a transplant than with a surgical resection.
Persons who have hepatocellular carcinoma and cirrhosis should talk with their doctor about the risks and benefits of treatment with liver transplantation versus surgical resection.
(Cancer, Vol 86, No 7, pp 1151-1158, 1999)