The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Treatment of Hepatocellular Carcinoma Associated with Cirrhosis in the Era of Liver Transplantation

Eytan Mor, MD; Ran Tur Kaspa, MD; Patricia Sheiner, MD; and Myron Schwartz, MD
[+] Article, Author, and Disclosure Information

From Rabin Medical Center, Petah-Tikva, Israel; and Mount Sinai Medical Center, New York, New York. Acknowledgment: The authors thank Nancy Ehrlich for editorial assistance. Requests for Reprints: Eytan Mor, MD, Department of Transplantation, Rabin Medical Center, Beilinson Campus, Petah-Tikva 49100, Israel; e-mail, eytanmor@mail.netvision.net.il. Current Author Addresses: Dr. Mor: Department of Transplantation, Rabin Medical Center, Beilinson Campus, Petah-Tikva 49100, Israel.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;129(8):643-653. doi:10.7326/0003-4819-129-8-199810150-00013
Text Size: A A A

Purpose: To review the treatment of cirrhotic patients with hepatocellular carcinoma in the era of liver transplantation and to determine the most appropriate approach to the treatment of patients at different stages of disease.

Data Sources: A MEDLINE search of English-language articles published between 1981 and 1997 and the clinical experience of the Mount Sinai Liver Transplant Program.

Study Selection: Selected studies were 1) original articles reporting results of resection and transplantation in the treatment of hepatocellular carcinoma in cirrhotic patients and 2) initial reports from major transplantation centers of multimethod therapies combining chemotherapy with transplantation.

Data Extraction: Study designs were assessed with careful attention to methods and aims. Relevant data on patient population, tumor stage distribution, treatment, survival, and rate of recurrent disease were extracted and analyzed.

Data Synthesis: Options for the treatment of hepatocellular carcinoma in cirrhotic patients vary according to tumor stage and severity of underlying liver disease. Resection remains an important method primarily in eastern countries, where the screening of high-risk populations has been associated with early detection of small asymptomatic lesions. Long-term survival after resection, however, is low. In western countries, liver transplantation is becoming the treatment of choice in patients with advanced cirrhosis and small, unresectable lesions; resection is reserved for cirrhotic patients with small, peripheral lesions and preserved hepatic function. Minimally invasive procedures (such as percutaneous ethanol injection and transarterial chemoembolization) have been developed to treat unresectable tumors. Transarterial chemoembolization may also be effective in patients with advanced cirrhosis and unresectable lesions who are awaiting transplantation.

Conclusions: The efficacy of liver transplantation for hepatocellular carcinoma has been proven mainly in patients with advanced cirrhosis and small lesions. Future studies may clarify the role of approaches combining neoadjuvant chemotherapy with transplantation for large (stage III) tumors.


Grahic Jump Location
Figure 1.
Approach to management of the cirrhotic patient with a small hepatocellular carcinoma.

PEI = percutaneous ethanol injection; TACE = transarterial chemoembolization.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.