Clinical management of recurrent hepatocellular carcinoma

Objective: The aim of this study was to evaluate the long term benefits of the aggressive treatments with resection or transarterial chemoembolization (TACE) for recurrent hepatocellular carcinoma (HCC). Summary Background Data: Primary HCC is one of the most fatal malignancies in Taiwan. The result of resection for HCC remains unsatisfactory, primarily due to the high recurrence rate. To improve surgical results, recurrent HCC must be treated with aggressive resection or TACE. Methods: The authors evaluated the results of repeated hepatic resection among 25 patients with recurrent HCC and of TACE among 12 patients with resectable recurrent HCC. The outcomes of an additional 64 patients with unresectable recurrent HCC were also evaluated. Results: During the follow up period from 2-112 months, 52% (13/25) of patients receiving repeat resection (group 1) were alive, whereas 42% (5/12) of patients receiving TACE (group 2) were alive. No perioperative deaths within 30 days after surgery occurred in the repeated resection group. The cumulative survival rates at 1,2, 3, and 5 years after the first operation were 92%, 84%, 71.6%, and 65.1% in group 1 and 833%, 75%, 75%, and 22.5% in group 2. The survival rates at 6 months and at 1,2, and 3 years after recurrence were 92%, 72%, 64%, and 44.8% in group 1 and 833%, 75%, 66.7%, and 48% in group 2. The survival of patients with unresectable recurrent HCC was much worse: 1-, 2-, 3-, and 5-year survival after surgery was 57.8%, 29.8%, 15.5%, and 0%; and 6 month and 1-, 2-, and 3 year survival after recurrence was 46.5%, 29.2%, 12.5% and 7.8%. Conclusions: More aggressive treatment with repeated hepatic resection can prolong survival time after recurrence of HCC in selected patients. However, TACE can also achieve good results although it is not thought of as curative.