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©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Nov 7, 2014; 20(41): 15007-15017
Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15007
Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15007
Table 1 American liver tumor study group modified tumor-node-metastasis staging classification for hepatocellular carcinoma
Tumor classification | Definition | Stage | Criteria |
T0, N0, M0 | No tumor found | ||
T1 | 1 nodule < 2.0 cm | Stage I | T1 lesion |
T2 | 1 nodule 2-5 cm, 2 or 3 nodules each less than 3 cm | Stage II | T2 lesion |
T3 | 1 nodule > 5 cm, 2 or 3 nodules, at least 1 > 3 cm | Stage III | T3 lesion |
T4a | ≥ 4 nodules, any size | Stage IVa1 | T4a |
T4b | T2, T3 or T4a plus gross intrahepatic, portal or hepatic vein involvement as indicated by CT, MRI or US | Stage IVa2 | T4b |
N1 | Regional (porta hepatis) node involvement | Stage IVb | Any N1 or M1 |
M1 | Metastatic disease including extrahepatic portal or hepatic vein involvement |
Table 2 Current indications of commonly used treatment options for hepatocellular carcinoma
Current indications | |
Hepatic resection | Treatment of choice in patients with resectable disease and absence of cirrhosis |
Indicated in selected patients with limited disease and early cirrhosis (Child-Pugh A) | |
Limited role as a bridge to OLT | |
OLT | Standard therapy for patients with HCC and Cirrhosis within Milan criteria |
OLT may be indicated in select patients with tumors outside Milan criteria but within UCSF criteria | |
Indicated in select patients with stage III and IV HCC downstaged to within Milan criteria with use of neo-adjuvant therapy | |
Non resectional ablative therapies (RFA, microwave, TACE, TAE, HIFU etc.) | Indicated as primary therapy only in patients with HCC who are not candidates for curative resection or OLT |
Increasingly used alone or in combination as bridging therapy in patients awaiting OLT or to downstage stage advanced stage disease to within Milan criteria | |
Established role in palliative treatment of HCC (not discussed in this paper) |
Table 3 Overview of the common modalities used in the treatment of hepatocellular carcinoma
Treatment modality | Advantages | Disadvantages |
Hepatic resection | Readily accessible | Not indicated for patients with advanced cirrhosis |
No waiting period | High recurrence rates (> 50% at 5 yr) | |
5 yr survival of > 50% in carefully selected patients | Risk of post operative haptic failure | |
Peri-operative mortality < 5% | Does not address risk of cancer in residual liver | |
Not limited by tumor size | ||
OLT | Low rate of recurrence in carefully selected patients | Restricted by size and number of lesions |
Post transplant survival rates similar to patients with OLT for all other causes | Risk of dropout while on wait list (38% drop out rate after 12 mo) | |
TACE/TAE | Indicated for treatment in patients not candidates for resection or OLT | Low curative potential when used alone with high recurrence rates |
Effective role as bridge for transplantation | Efficacy decreased for large sized tumors | |
Established role in downstaging HCC to make patients OLT eligible | Does not address risk of cancer in residual liver | |
Evidence of survival benefit after OLT when used as neo-adjuvant therapy in select patients | ||
Relatively low morbidity | ||
RFA | Highly effective for HCC ≤ 3 cm | Decreased effectiveness in HCC ≥ 4 cm with high recurrence rates |
Effective bridge for OLT by decreasing drop out rate on wait list | May be limited by proximity of HCC to vascular pedicels | |
Established role in downstaging HCC to make patients OLT eligible | Does not address risk of cancer in residual liver | |
Relatively low morbidity and mortality |
- Citation: Khan AS, Fowler KJ, Chapman WC. Current surgical treatment strategies for hepatocellular carcinoma in North America. World J Gastroenterol 2014; 20(41): 15007-15017
- URL: https://www.wjgnet.com/1007-9327/full/v20/i41/15007.htm
- DOI: https://dx.doi.org/10.3748/wjg.v20.i41.15007