Prognosis of primary hepatocellular carcinoma

Prognosis of 600 consecutive patients with hepatocellular carcinoma was analyzed in relation to treatment. They were divided into three stages based on four parameters of advanced disease: ascites, tumor greater than 50% of the two-dimensional size of the liver, serum albumin below 3 gm per dl, and serum bilirubin above 3 mg per dl. Stage I had none of these signs; Stage II one or two signs, and Stage III three or all signs. Of 600 patients, 98 had resection, 333 had nonsurgical treatment (158 treated by intraarterial chemotherapy, 94 systemic chemotherapy, 77 transcatheter embolization, and 4 others) and 169 no treatment. The median survival of untreated patients was only 1.6 months from diagnosis, and no untreated Stage III patient lived more than 3 months; there was a median survival of 0.7 month. Surgically treated patients lived significantly longer than nonsurgical patients of comparable stages; median survival was 19.6 months in the former and 2.8 months in the latter. Whereas Stage I patients did fairly well without treatment, chemotherapy significantly prolonged survival of patients of Stages II and III. These results suggest that early diagnosis and hepatic resection improve prognosis in patients with hepatocellular carcinoma in the areas where this cancer frequently emerges unicentrically. In view of the generally poor prognosis, liver transplantation is recommended when resection is not possible or indicated, and before extrahepatic metastasis occurs.