Prognosis of Primary Hepatocellular Carcinoma

The pathologic findings of 232 consecutive cases of hepatocellular carcinoma (HCC) autopsied during the past ten years at Kurume, Japan, were analyzed from the point of view of global epidemiology, in relation to clinical feature, and in regard to incidence, age, sex, etiologic factors, size of liver, changes in noncancer parenchyma, gross type of tumor, extrahepatic metastases, intravascular and intraductal growths, cancer cell histology, hepatitis B surface antigen (HBsAg) in hepatocytes and cancer cells, liver cell dysplasia, and frequency and clinicopathologic characteristics of minute HCC. Furthermore, postmortem hepatic arteriography and portography were done in 152 livers for comparison with gross anatomy and celiac angiograms. It was found that: (1) epidemiologically, HCC in Japan is distinct from that in the West that it is frequently encapsulated, livers are generally small because of frequent and advanced cirrhosis and small cancer, minute HCC, is not uncommon at autopsy, cirrhosis most commonly associated is the one with thin stroma and medium size nodules, and micronodular cirrhosis is very rare despite frequent alcohol abuse; (2) HCC is increasing in incidence; (3) HBsAg is frequently found in parenchyma; (4) liver cell dysplasia is indirectly related to HBsAg with no evidence for premalignancy; (5) the lung is the most frequent site of metastasis but peritoneal dissemination is unusual; (6) intraportal tumor growth is very common and the hepatic vein is less frequently affected; (7) growth in the major bile duct is frequently associated with intraportal growth and clinically presents as obstructive jaundice; and (8) tumor is supplied solely by arteries and celiac arteriograms are closely correlated with gross pathologic findings.

Statistical analyses have been made by the Liver Cancer Study Group of Japan of 4031 cases of primary liver cancers diagnosed at 155 institutes during the period of Jan. 1, 1968-Dec. 31, 1977, based on the questionnaire in the form of individual file. They comprised 2411 cases of hepatocellular carcinoma, 268 of cholangiocellular carcinoma, 58 of the mixed type, 69 of hepatoblastoma, 23 of others, and 1202 cases with only clinical diagnosis. The survey and analyses mostly based on the histology-proven cases included gross anatomical and histological features of tumors, grades of anaplasia and growth patterns of tumor cells, pathology of noncancerous liver portion, frequency of accompanying cirrhosis or fibrosis, distant metastases, past history, frequency of hepatitis in the past history, frequency of positive HBsAg and anti-HBs, familial clustering of positive HBsAg tests, age distribution, subjective symptoms, objective signs, serum alpha-fetoprotein, celiac angiography findings, number of operations performed, kinds of surgical approaches made, extents of hepatic resection, prognosis in terms of survival in relation to various surgical treatments, chemotherapeutic agents used and routes of administration, prognosis as related to the accompanying parenchymal liver disease, and overall survival.

Radiological and clinical experience with transcatheter intravascular occlusion of abdominal and pelvic tumors in 55 patients is presented. Major indications include control of hemorrhage, palliation of local tumor symptoms, and preoperative management of facilitate surgery. Methods of occlusion included embolization (clot, subcutaneous tissue, and Gelfoam), introduction of a stainless steel coil into larger vessels, and balloon catheters. Hemorrhage was controlled in 8 of 12 patients with bleeding gastrointestinal and pelvic tumors. Experience in 36 patients with hypernephroma is discussed. Initial observations are presented, including occlusion of the hepatic artery for dearterialization of primary and secondary neoplasms and of the splenic artery for hypersplenism.