Treatment of fibrolamellar hepatoma with subtotal hepatectomy or transplantation

Abstract

Fibrolamellar hepatoma (FL-HCC) is an uncommon variant previously reported [4][5][6] ), less than 100 such cases can be found in the literature. 2,3,[7][8][9][10][11][12][13][14][15][16][17] In our series, we have compared the of hepatocellular carcinoma (HCC), distinguished by histopathological features suggesting greater differentiation than survival of patients with FL-HCC with that of patients with conventional HCC who were treated by the same team over conventional HCC. However, the optimal treatment and the prognosis of FL-HCC have been controversial. Follow-up a 27-year period. studies are available from 1 year to 27 years, after 41 patients with FL-HCC were treated with partial hepatectomy (PHx) PATIENTS AND METHODS (28 patients) or liver transplantation (13 patients). In thisCase Material retrospective study, the effect on outcome was determined for the pTNM stage and other prognostic factors routinely Between 1968 and 1995, 477 (range, 9-66; median, 25) (Fig. 1). The median follow-up was 58 tumor-free survival than those with negative nodes (P õ .015).{ 9.3 months. Patient survival was most adversely affected by the presence of vascular invasion (P õ .05). FL-HCC is an indolently grow- Clinicopathological Characteristicsing tumor of the liver, which usually was diagnosed in our patients at a stage too advanced for effective surgical treatmentThe pathology reports and operative findings were used to deterof most conventional HCC. Nevertheless, long-term survival mine: the principal tumor size, number of lesions, lobar distribufrequently was achieved with aggressive surgical treatment. tion, vascular and lymphatic tumor extension, surgical margins, When a subtotal hepatectomy could not be performed, total distant metastases, and the presence or absence of associated cirrhosis. When available, the tumor markers were recorded as well as hepatectomy (THx) with liver transplantation was a valuable the virus markers (hepatitis C virus, hepatitis B virus).

Clinicopathologic Features and Prognosis of Young Patients With Hepatocellular Carcinoma in a Large German Cohort

“…In 5 publications, median ages ranged from 23 to 31 years. [17][18][19][20][21] A trend toward shorter survival of our young patients with FL-HCC compared with the other young patients could be seen. The only other publication from a western country (Mexico) in young HCC patients shows many similarities to our data.…”

Mediastinal metastasis from a fibrolamellar hepatocellular carcinoma: Report of a case

“…15 FL-HCC occurs in the setting of hepatitis B, hepatitis C, and cirrhosis, with a frequency of 0%-10%. [10][11][12][13][14] The best treatment for FL-HCC is a surgical resection whenever possible. After a surgical resection, the 5-year survival rate is 37%-76%, as shown in Table 1.…”

“…11 About 20%-50% of FL-HCC patients have been reported to have lymph node metastasis in the initial operation; therefore an aggressive initial operation along with a regional lymphadenectomy should be performed for the primary lesion. [10][11][12][13][14] Because there is still no effective chemotherapy for FL-HCC, repeated resection of recurrent tumors should be considered.…”

Hepatoma of the liver - resection or transplantation?

“…The largest single-center report originates from Pittsburgh [40]. Pinna et al described the treatment of fibrolamellar carcinoma with resection (n=28) or transplantation (n=13) in 41 patients.…”