Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1994 Mar;219(3):236–247. doi: 10.1097/00000658-199403000-00003

Current treatment modalities for hepatocellular carcinoma.

D G Farmer 1, M H Rosove 1, A Shaked 1, R W Busuttil 1
PMCID: PMC1243131  PMID: 8147605

Abstract

OBJECTIVE: This study evaluated the currently available treatment modalities for hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: One of the most common tumors worldwide, HCC has several known risk factors. Untreated HCC typically has a dismal prognosis. Early detection remains the key to successful treatment of this malignancy. Surgical resection has been the mainstay of treatment for HCC, but newer modalities have been recently introduced. METHODS: The authors evaluated the treatment modalities for HCC. RESULTS: Surgical resection affords 5-year survival rates as high as 45% with more favorable subgroups having 1) small tumors, 2) well-differentiated tumors, 3) unifocal tumors, 4) lack of vascular invasion, 5) absence of cirrhosis, and 6) the fibrolamellar variant (FL-HCC). Resection has been limited primarily by low resectability rates and recurrent disease. Newer therapeutic modalities that appear the most promising are transarterial chemoembolization and percutaneous ethanol injection. Neither therapy has been evaluated in a prospective randomized manner. Combination chemotherapy and surgical intervention may provide the best results, but randomized controlled trials with long-term follow-up are needed. As single-treatment modalities, radiation therapy, intravenous chemotherapy, intra-arterial chemotherapy, and immunotherapy play limited palliative roles. CONCLUSIONS: Surgical resection in the form of partial or total hepatectomy is the preferred treatment for HCC. The early detection of tumors by screening high-risk populations is crucial. Randomized trials of combinations of chemotherapy and surgical resection are needed to demonstrate their potential utility for treatment.

Full text

PDF
236

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abelev G. I. Production of embryonal serum alpha-globulin by hepatomas: review of experimental and clinical data. Cancer Res. 1968 Jul;28(7):1344–1350. [PubMed] [Google Scholar]
  2. Akagi G., Furuya K., Kanamura A., Chihara T., Otsuka H. Liver cell dysplasia and hepatitis B surface antigen in liver cirrhosis and hepatocellular carcinoma. Cancer. 1984 Jul 15;54(2):315–318. doi: 10.1002/1097-0142(19840715)54:2<315::aid-cncr2820540223>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  3. Almersjö O., Bengmark S., Rudenstam C. M., Hafström L., Nilsson L. A. Evaluation of hepatic dearterialization in primary and secondary cancer of the liver. Am J Surg. 1972 Jul;124(1):5–9. doi: 10.1016/0002-9610(72)90155-9. [DOI] [PubMed] [Google Scholar]
  4. Aoyagi Y., Suzuki Y., Igarashi K., Saitoh A., Oguro M., Yokota T., Mori S., Nomoto M., Isemura M., Asakura H. The usefulness of simultaneous determinations of glucosaminylation and fucosylation indices of alpha-fetoprotein in the differential diagnosis of neoplastic diseases of the liver. Cancer. 1991 May 1;67(9):2390–2394. doi: 10.1002/1097-0142(19910501)67:9<2390::aid-cncr2820670928>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  5. BREEDIS C., YOUNG G. The blood supply of neoplasms in the liver. Am J Pathol. 1954 Sep-Oct;30(5):969–977. [PMC free article] [PubMed] [Google Scholar]
  6. Balasegaram M. Complete hepatic dearterialization for primary carcinoma of the liver. Report of twenty-four patients. Am J Surg. 1972 Sep;124(3):340–345. doi: 10.1016/0002-9610(72)90038-4. [DOI] [PubMed] [Google Scholar]
  7. Bengmark S., Rosengren K. Angiographic study of the collateral circulation to the liver after ligation of the hepatic artery in man. Am J Surg. 1970 Jun;119(6):620–624. doi: 10.1016/0002-9610(70)90228-x. [DOI] [PubMed] [Google Scholar]
  8. Bismuth H., Castaing D., Ericzon B. G., Otte J. B., Rolles K., Ringe B., Sloof M. Hepatic transplantation in Europe. First Report of the European Liver Transplant Registry. Lancet. 1987 Sep 19;2(8560):674–676. doi: 10.1016/s0140-6736(87)92453-6. [DOI] [PubMed] [Google Scholar]
  9. Bismuth H., Houssin D., Ornowski J., Meriggi F. Liver resections in cirrhotic patients: a Western experience. World J Surg. 1986 Apr;10(2):311–317. doi: 10.1007/BF01658152. [DOI] [PubMed] [Google Scholar]
  10. Bismuth H., Morino M., Sherlock D., Castaing D., Miglietta C., Cauquil P., Roche A. Primary treatment of hepatocellular carcinoma by arterial chemoembolization. Am J Surg. 1992 Apr;163(4):387–394. doi: 10.1016/0002-9610(92)90039-t. [DOI] [PubMed] [Google Scholar]
  11. Busuttil R. W., Colonna J. O., 2nd, Hiatt J. R., Brems J. J., el Khoury G., Goldstein L. I., Quinones-Baldrich W. J., Abdul-Rasool I. H., Ramming K. P. The first 100 liver transplants at UCLA. Ann Surg. 1987 Oct;206(4):387–402. doi: 10.1097/00000658-198710000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Callea F. Natural history of hepatocellular carcinoma as viewed by the pathologist. Appl Pathol. 1988;6(2):105–116. [PubMed] [Google Scholar]
  13. Chen M. F., Hwang T. L., Jeng L. B., Jan Y. Y., Wang C. S., Chou F. F. Hepatic resection in 120 patients with hepatocellular carcinoma. Arch Surg. 1989 Sep;124(9):1025–1028. doi: 10.1001/archsurg.1989.01410090031006. [DOI] [PubMed] [Google Scholar]
  14. Colombo M. Hepatocellular carcinoma. J Hepatol. 1992 May;15(1-2):225–236. doi: 10.1016/0168-8278(92)90041-m. [DOI] [PubMed] [Google Scholar]
  15. Craig J. R., Peters R. L., Edmondson H. A., Omata M. Fibrolamellar carcinoma of the liver: a tumor of adolescents and young adults with distinctive clinico-pathologic features. Cancer. 1980 Jul 15;46(2):372–379. doi: 10.1002/1097-0142(19800715)46:2<372::aid-cncr2820460227>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  16. Di Bisceglie A. M., Rustgi V. K., Hoofnagle J. H., Dusheiko G. M., Lotze M. T. NIH conference. Hepatocellular carcinoma. Ann Intern Med. 1988 Mar;108(3):390–401. doi: 10.7326/0003-4819-108-3-390. [DOI] [PubMed] [Google Scholar]
  17. Du M. Q., Hutchinson W. L., Johnson P. J., Williams R. Differential alpha-fetoprotein lectin binding in hepatocellular carcinoma. Diagnostic utility at low serum levels. Cancer. 1991 Jan 15;67(2):476–480. doi: 10.1002/1097-0142(19910115)67:2<476::aid-cncr2820670226>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  18. Ebara M., Ohto M., Sugiura N., Kita K., Yoshikawa M., Okuda K., Kondo F., Kondo Y. Percutaneous ethanol injection for the treatment of small hepatocellular carcinoma. Study of 95 patients. J Gastroenterol Hepatol. 1990 Nov-Dec;5(6):616–626. doi: 10.1111/j.1440-1746.1990.tb01115.x. [DOI] [PubMed] [Google Scholar]
  19. Falkson G., Cnaan A., Schutt A. J., Ryan L. M., Falkson H. C. Prognostic factors for survival in hepatocellular carcinoma. Cancer Res. 1988 Dec 15;48(24 Pt 1):7314–7318. [PubMed] [Google Scholar]
  20. Grigioni W. F., Garbisa S., D'Errico A., Baccarini P., Stetler-Stevenson W. G., Liotta L. A., Mancini A. M. Evaluation of hepatocellular carcinoma aggressiveness by a panel of extracellular matrix antigens. Am J Pathol. 1991 Mar;138(3):647–654. [PMC free article] [PubMed] [Google Scholar]
  21. Haug C. E., Jenkins R. L., Rohrer R. J., Auchincloss H., Delmonico F. L., Freeman R. B., Lewis W. D., Cosimi A. B. Liver transplantation for primary hepatic cancer. Transplantation. 1992 Feb;53(2):376–382. doi: 10.1097/00007890-199202010-00021. [DOI] [PubMed] [Google Scholar]
  22. Hwang T. L., Chen M. F., Lee T. Y., Chen T. J., Lin D. Y., Liaw Y. F. Resection of hepatocellular carcinoma after transcatheter arterial embolization. Reevaluation of the advantages and disadvantages of preoperative embolization. Arch Surg. 1987 Jul;122(7):756–759. doi: 10.1001/archsurg.1987.01400190022004. [DOI] [PubMed] [Google Scholar]
  23. Ihde D. C., Matthews M. J., Makuch R. W., McIntire K. R., Eddy J. L., Seeff L. B. Prognostic factors in patients with hepatocellular carcinoma receiving systemic chemotherapy. Identification of two groups of patients with prospects for prolonged survival. Am J Med. 1985 Mar;78(3):399–406. doi: 10.1016/0002-9343(85)90330-4. [DOI] [PubMed] [Google Scholar]
  24. Ikeda K., Saitoh S., Tsubota A., Arase Y., Chayama K., Kumada H., Watanabe G., Tsurumaru M. Risk factors for tumor recurrence and prognosis after curative resection of hepatocellular carcinoma. Cancer. 1993 Jan 1;71(1):19–25. doi: 10.1002/1097-0142(19930101)71:1<19::aid-cncr2820710105>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
  25. Ismail T., Angrisani L., Gunson B. K., Hübscher S. G., Buckels J. A., Neuberger J. M., Elias E., McMaster P. Primary hepatic malignancy: the role of liver transplantation. Br J Surg. 1990 Sep;77(9):983–987. doi: 10.1002/bjs.1800770908. [DOI] [PubMed] [Google Scholar]
  26. Iwatsuki S., Gordon R. D., Shaw B. W., Jr, Starzl T. E. Role of liver transplantation in cancer therapy. Ann Surg. 1985 Oct;202(4):401–407. doi: 10.1097/00000658-198510000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Iwatsuki S., Starzl T. E. Personal experience with 411 hepatic resections. Ann Surg. 1988 Oct;208(4):421–434. doi: 10.1097/00000658-198810000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Iwatsuki S., Starzl T. E., Sheahan D. G., Yokoyama I., Demetris A. J., Todo S., Tzakis A. G., Van Thiel D. H., Carr B., Selby R. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg. 1991 Sep;214(3):221–229. doi: 10.1097/00000658-199109000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Iwatsuki S., Starzl T. E., Todo S., Gordon R. D., Esquivel C. O., Tzakis A. G., Makowka L., Marsh J. W., Koneru B., Stieber A. Experience in 1,000 liver transplants under cyclosporine-steroid therapy: a survival report. Transplant Proc. 1988 Feb;20(1 Suppl 1):498–504. [PMC free article] [PubMed] [Google Scholar]
  30. Jenkins R. L., Pinson C. W., Stone M. D. Experience with transplantation in the treatment of liver cancer. Cancer Chemother Pharmacol. 1989;23 (Suppl):S104–S109. doi: 10.1007/BF00647252. [DOI] [PubMed] [Google Scholar]
  31. Kew M. C., Popper H. Relationship between hepatocellular carcinoma and cirrhosis. Semin Liver Dis. 1984 May;4(2):136–146. doi: 10.1055/s-2008-1040653. [DOI] [PubMed] [Google Scholar]
  32. Kinami Y., Takashima S., Miyazaki I. Hepatic resection for hepatocellular carcinoma associated with liver cirrhosis. World J Surg. 1986 Apr;10(2):294–301. doi: 10.1007/BF01658148. [DOI] [PubMed] [Google Scholar]
  33. Lai E. C., Choi T. K., Tong S. W., Ong G. B., Wong J. Treatment of unresectable hepatocellular carcinoma: results of a randomized controlled trial. World J Surg. 1986 Jun;10(3):501–509. doi: 10.1007/BF01655321. [DOI] [PubMed] [Google Scholar]
  34. Larmi T. K., Kärkölä P., Klintrup H. E., Heikkinen E. Treatment of patients with hepatic tumors and jaundice by ligation of the hepatic artery. Arch Surg. 1974 Feb;108(2):178–183. doi: 10.1001/archsurg.1974.01350260034007. [DOI] [PubMed] [Google Scholar]
  35. Livraghi T., Salmi A., Bolondi L., Marin G., Arienti V., Monti F., Vettori C. Small hepatocellular carcinoma: percutaneous alcohol injection--results in 23 patients. Radiology. 1988 Aug;168(2):313–317. doi: 10.1148/radiology.168.2.2839865. [DOI] [PubMed] [Google Scholar]
  36. Matsuhashi N., Moriyama T., Nakamura I., Ishikawa T., Ohnishi S., Nakagama H., Imawari M., Takaku F. Adoptive immunotherapy of primary and metastatic liver cancer via hepatic artery catheter. Eur J Cancer. 1990;26(10):1106–1107. doi: 10.1016/0277-5379(90)90065-2. [DOI] [PubMed] [Google Scholar]
  37. Monden M., Sakon M., Gotoh M., Kanai T., Umeshita K., Wang K. S., Sakurai M., Kuroda C., Okamura J., Mori T. Selection of therapeutic modalities for hepatocellular carcinoma in patients with multiple hepatic lesions. Cancer Chemother Pharmacol. 1992;31 (Suppl):S38–S44. doi: 10.1007/BF00687103. [DOI] [PubMed] [Google Scholar]
  38. Nagao T., Inoue S., Goto S., Mizuta T., Omori Y., Kawano N., Morioka Y. Hepatic resection for hepatocellular carcinoma. Clinical features and long-term prognosis. Ann Surg. 1987 Jan;205(1):33–40. doi: 10.1097/00000658-198701000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Nagasue N., Galizia G., Kohno H., Chang Y. C., Hayashi T., Yamanoi A., Nakamura T., Yukaya H. Adverse effects of preoperative hepatic artery chemoembolization for resectable hepatocellular carcinoma: a retrospective comparison of 138 liver resections. Surgery. 1989 Jul;106(1):81–86. [PubMed] [Google Scholar]
  40. Nagasue N., Yukaya H., Ogawa Y., Sasaki Y., Chang Y. C., Niimi K. Clinical experience with 118 hepatic resections for hepatocellular carcinoma. Surgery. 1986 Jun;99(6):694–701. [PubMed] [Google Scholar]
  41. Nagorney D. M., van Heerden J. A., Ilstrup D. M., Adson M. A. Primary hepatic malignancy: surgical management and determinants of survival. Surgery. 1989 Oct;106(4):740–749. [PubMed] [Google Scholar]
  42. Nakamura K., Takashima S., Takada K., Fujimoto K., Kaminou T., Nakatsuka H., Minakuchi K., Onoyama Y. Clinical evaluation of intermittent arterial infusion chemotherapy with an implanted reservoir for hepatocellular carcinoma. Cancer Chemother Pharmacol. 1992;31 (Suppl):S93–S98. doi: 10.1007/BF00687115. [DOI] [PubMed] [Google Scholar]
  43. Nerenstone S. R., Ihde D. C., Friedman M. A. Clinical trials in primary hepatocellular carcinoma: current status and future directions. Cancer Treat Rev. 1988 Mar;15(1):1–31. doi: 10.1016/0305-7372(88)90007-2. [DOI] [PubMed] [Google Scholar]
  44. O'Grady J. G., Polson R. J., Rolles K., Calne R. Y., Williams R. Liver transplantation for malignant disease. Results in 93 consecutive patients. Ann Surg. 1988 Apr;207(4):373–379. doi: 10.1097/00000658-198804000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Okuda K. Hepatocellular carcinoma: recent progress. Hepatology. 1992 May;15(5):948–963. doi: 10.1002/hep.1840150532. [DOI] [PubMed] [Google Scholar]
  46. Olthoff K. M., Millis J. M., Rosove M. H., Goldstein L. I., Ramming K. P., Busuttil R. W. Is liver transplantation justified for the treatment of hepatic malignancies? Arch Surg. 1990 Oct;125(10):1261–1268. doi: 10.1001/archsurg.1990.01410220045007. [DOI] [PubMed] [Google Scholar]
  47. Order S. E., Stillwagon G. B., Klein J. L., Leichner P. K., Siegelman S. S., Fishman E. K., Ettinger D. S., Haulk T., Kopher K., Finney K. Iodine 131 antiferritin, a new treatment modality in hepatoma: a Radiation Therapy Oncology Group study. J Clin Oncol. 1985 Dec;3(12):1573–1582. doi: 10.1200/JCO.1985.3.12.1573. [DOI] [PubMed] [Google Scholar]
  48. Penn I. Hepatic transplantation for primary and metastatic cancers of the liver. Surgery. 1991 Oct;110(4):726–735. [PubMed] [Google Scholar]
  49. Pichlmayr R., Ringe B., Bechstein W. O., Lauchart W., Neuhaus P. Approach to primary liver cancer. Recent Results Cancer Res. 1988;110:65–73. doi: 10.1007/978-3-642-83293-2_9. [DOI] [PubMed] [Google Scholar]
  50. Pichlmayr R., Weimann A., Steinhoff G., Ringe B. Liver transplantation for hepatocellular carcinoma: clinical results and future aspects. Cancer Chemother Pharmacol. 1992;31 (Suppl):S157–S161. doi: 10.1007/BF00687127. [DOI] [PubMed] [Google Scholar]
  51. Pichlymayr R., Ringe B., Wittekind C., Bunzendahl H., Gubernatis G., Grote R., Mauz S., Grosse H. Liver grafting for malignant liver tumors. Transplant Proc. 1989 Feb;21(1 Pt 2):2403–2405. [PubMed] [Google Scholar]
  52. Ramming K. P. The effectiveness of hepatic artery infusion in treatment of primary hepatobiliary tumors. Semin Oncol. 1983 Jun;10(2):199–205. [PubMed] [Google Scholar]
  53. Ravikumar T. S., Steele G. D., Jr Hepatic cryosurgery. Surg Clin North Am. 1989 Apr;69(2):433–440. doi: 10.1016/s0039-6109(16)44798-5. [DOI] [PubMed] [Google Scholar]
  54. Ringe B., Pichlmayr R., Wittekind C., Tusch G. Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. World J Surg. 1991 Mar-Apr;15(2):270–285. doi: 10.1007/BF01659064. [DOI] [PubMed] [Google Scholar]
  55. Ringe B., Wittekind C., Bechstein W. O., Bunzendahl H., Pichlmayr R. The role of liver transplantation in hepatobiliary malignancy. A retrospective analysis of 95 patients with particular regard to tumor stage and recurrence. Ann Surg. 1989 Jan;209(1):88–98. doi: 10.1097/00000658-198901000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Risio M. Histology, histochemistry, tumor and serum markers in gastrointestinal tract cancer. Curr Opin Oncol. 1992 Aug;4(4):714–727. doi: 10.1097/00001622-199208000-00018. [DOI] [PubMed] [Google Scholar]
  57. Sachs E., Di Bisceglie A. M., Dusheiko G. M., Song E., Lyons S. F., Schoub B. D., Kew M. C. Treatment of hepatocellular carcinoma with recombinant leucocyte interferon: a pilot study. Br J Cancer. 1985 Jul;52(1):105–109. doi: 10.1038/bjc.1985.156. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Sakamoto M., Hirohashi S., Shimosato Y. Early stages of multistep hepatocarcinogenesis: adenomatous hyperplasia and early hepatocellular carcinoma. Hum Pathol. 1991 Feb;22(2):172–178. doi: 10.1016/0046-8177(91)90039-r. [DOI] [PubMed] [Google Scholar]
  59. Seki T., Nonaka T., Kubota Y., Mizuno T., Sameshima Y. Ultrasonically guided percutaneous ethanol injection therapy for hepatocellular carcinoma. Am J Gastroenterol. 1989 Nov;84(11):1400–1407. [PubMed] [Google Scholar]
  60. Sesto M. E., Vogt D. P., Hermann R. E. Hepatic resection in 128 patients: a 24-year experience. Surgery. 1987 Nov;102(5):846–851. [PubMed] [Google Scholar]
  61. Shiina S., Tagawa K., Unuma T., Takanashi R., Yoshiura K., Komatsu Y., Hata Y., Niwa Y., Shiratori Y., Terano A. Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study. Cancer. 1991 Oct 1;68(7):1524–1530. doi: 10.1002/1097-0142(19911001)68:7<1524::aid-cncr2820680711>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  62. Sitzmann J. V., Abrams R. Improved survival for hepatocellular cancer with combination surgery and multimodality treatment. Ann Surg. 1993 Feb;217(2):149–154. doi: 10.1097/00000658-199302000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Smalley S. R., Moertel C. G., Hilton J. F., Weiland L. H., Weiand H. S., Adson M. A., Melton L. J., 3rd, Batts K. Hepatoma in the noncirrhotic liver. Cancer. 1988 Oct 1;62(7):1414–1424. doi: 10.1002/1097-0142(19881001)62:7<1414::aid-cncr2820620729>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  64. Starzl T. E., Iwatsuki S., Shaw B. W., Jr, Nalesnik M. A., Farhi D. C., Van Thiel D. H. Treatment of fibrolamellar hepatoma with partial or total hepatectomy and transplantation of the liver. Surg Gynecol Obstet. 1986 Feb;162(2):145–148. [PMC free article] [PubMed] [Google Scholar]
  65. Stone M. J., Klintmalm G. B., Polter D., Husberg B. S., Mennel R. G., Ramsay M. A., Flemens E. R., Goldstein R. M. Neoadjuvant chemotherapy and liver transplantation for hepatocellular carcinoma: a pilot study in 20 patients. Gastroenterology. 1993 Jan;104(1):196–202. doi: 10.1016/0016-5085(93)90852-4. [DOI] [PubMed] [Google Scholar]
  66. Takayama T., Makuuchi M., Hirohashi S., Sakamoto M., Okazaki N., Takayasu K., Kosuge T., Motoo Y., Yamazaki S., Hasegawa H. Malignant transformation of adenomatous hyperplasia to hepatocellular carcinoma. Lancet. 1990 Nov 10;336(8724):1150–1153. doi: 10.1016/0140-6736(90)92768-d. [DOI] [PubMed] [Google Scholar]
  67. Takayasu K. Interventional angiography for primary and secondary hepatic malignancies: a review. Jpn J Clin Oncol. 1990 Sep;20(3):225–231. [PubMed] [Google Scholar]
  68. Takayasu K., Moriyama N., Muramatsu Y., Makuuchi M., Hasegawa H., Okazaki N., Hirohashi S. The diagnosis of small hepatocellular carcinomas: efficacy of various imaging procedures in 100 patients. AJR Am J Roentgenol. 1990 Jul;155(1):49–54. doi: 10.2214/ajr.155.1.1693808. [DOI] [PubMed] [Google Scholar]
  69. Tanaka K., Nakamura S., Numata K., Okazaki H., Endo O., Inoue S., Takamura Y., Sugiyama M., Ohaki Y. Hepatocellular carcinoma: treatment with percutaneous ethanol injection and transcatheter arterial embolization. Radiology. 1992 Nov;185(2):457–460. doi: 10.1148/radiology.185.2.1329143. [DOI] [PubMed] [Google Scholar]
  70. Tsuzuki T., Sugioka A., Ueda M., Iida S., Kanai T., Yoshii H., Nakayasu K. Hepatic resection for hepatocellular carcinoma. Surgery. 1990 May;107(5):511–520. [PubMed] [Google Scholar]
  71. Venook A. P., Stagg R. J., Lewis B. J., Chase J. L., Ring E. J., Maroney T. P., Hohn D. C. Chemoembolization for hepatocellular carcinoma. J Clin Oncol. 1990 Jun;8(6):1108–1114. doi: 10.1200/JCO.1990.8.6.1108. [DOI] [PubMed] [Google Scholar]
  72. Wood W. J., Rawlings M., Evans H., Lim C. N. Hepatocellular carcinoma: importance of histologic classification as a prognostic factor. Am J Surg. 1988 May;155(5):663–666. doi: 10.1016/s0002-9610(88)80139-9. [DOI] [PubMed] [Google Scholar]
  73. Yamada R., Kishi K., Sonomura T., Tsuda M., Nomura S., Satoh M. Transcatheter arterial embolization in unresectable hepatocellular carcinoma. Cardiovasc Intervent Radiol. 1990 Jun-Jul;13(3):135–139. doi: 10.1007/BF02575464. [DOI] [PubMed] [Google Scholar]
  74. Yokoyama I., Todo S., Iwatsuki S., Starzl T. E. Liver transplantation in the treatment of primary liver cancer. Hepatogastroenterology. 1990 Apr;37(2):188–193. [PMC free article] [PubMed] [Google Scholar]
  75. Yoshimi F., Nagao T., Inoue S., Kawano N., Muto T., Gunji T., Ohnishi S., Imawari M. Comparison of hepatectomy and transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma: necessity for prospective randomized trial. Hepatology. 1992 Sep;16(3):702–706. doi: 10.1002/hep.1840160314. [DOI] [PubMed] [Google Scholar]
  76. Yu Y. Q., Xu D. B., Zhou X. D., Lu J. Z., Tang Z. Y., Mack P. Experience with liver resection after hepatic arterial chemoembolization for hepatocellular carcinoma. Cancer. 1993 Jan 1;71(1):62–65. doi: 10.1002/1097-0142(19930101)71:1<62::aid-cncr2820710111>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  77. Zhou X. D., Tang Z. Y., Yu Y. Q., Ma Z. C. Clinical evaluation of cryosurgery in the treatment of primary liver cancer. Report of 60 cases. Cancer. 1988 May 1;61(9):1889–1892. doi: 10.1002/1097-0142(19880501)61:9<1889::aid-cncr2820610928>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES