[Changing prognosis of primary liver cancer: some aspects to improve long-term survival]

The authors reported the changing prognosis of primary liver cancer (PLC) during the last three decades and the factors improving long-term results. Two thousand three hundred and eighty eight pathologically proven PLC cases were analyzed. Of them, 569 cases (23.8%) were small-sized PLC (< or = 5 cm in diameter). Hepatic resection was performed in 1,650 cases (69.1%) and local resection was done in 1,202 of the 1,650 (72.8%). Follow-up study was carried out every 2-3 months during the first 2 years after resection and every 6 months thereafter. For some unresectable huge PLC, cytoreduction and subsequent resection were performed. Five-year survival rate was 4.8% in 1958-1970 (n = 187), 11.2% in 1971-1982 (n = 582), and 45.7% in 1983-1994 (n = 1,628), respectively. Re-resection of subclinical recurrence was performed in 147 cases. Cytoreduction and subsequent resection were carried out in 71 cases. It is concluded that markedly changing prognosis of PLC was observed; factors improving long-term survival included (1) early detection and radical resection, (2) local resection instead of lobectomy, (3) re-resection for subclinical recurrence, and (4) cytoreduction and subsequent resection for otherwise unresectable PLC.