Hepatocellular carcinoma: a review of 30 years experience

The clinical characteristics of 51 patients with hepatocellular carcinoma over a 30-year period were reviewed. Presenting symptoms commonly included abdominal pain (47 percent), anorexia (41 percent), and ascites (22 percent); however, the ability to make an early diagnosis was complicated by a variety of unusual symptoms accounting for 23 percent of presentations. While cirrhosis (41 percent) was a common associated finding, most patients (92 percent) had no prior diagnosis of liver disease. Histologic diagnosis was made by blind percutaneous biopsy (three performed, 100 percent positive), needle aspiration biopsy (four performed, 100 percent positive), laparotomy (26 percent, 85 percent positive), or autopsy (20). Only six of 51 patients underwent surgical resection. The overall median survival of 4.1 months and seven percent two-year survival in our series illustrates that thus far medical treatment is not helpful in prolonging life. Attempts to elucidate more effective systemic and regional therapy for established cases of hepatocellular carcinoma and attempts to reduce the incidence of the disease in high-risk populations through the use of hepatitis B vaccine are therefore advised.