Adult Primary Liver Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - General Information About Adult Primary Liver Cancer
If, despite the use of two imaging modalities, a nodule larger than 1 cm remains uncharacterized in a patient at high risk for HCC (i.e., with only one or no classic enhancement pattern), a liver biopsy can be considered.[5,22]
A liver biopsy may be performed when a diagnosis of HCC is not established by a dynamic imaging modality (three-phase CT or MRI) for liver nodules 1 cm or larger in high-risk patients.
Natural History and Prognostic Factors
The natural history of early tumors is poorly known because the majority of patients are treated. However, older reports have described 3-year survival rates of 13% to 21% without any specific treatment.[24,25] At present, only 10% to 23% of HCC patients may be surgical candidates for curative-intent treatment.[26,27] The 5-year overall survival rates for patients with early HCC who are undergoing liver transplant or liver resection are 44% to 78% and 27% to 70%, respectively.
The natural course of advanced-stage HCC is better known. Untreated patients with advanced disease usually survive less than 6 months. The 1-year and 2-year survival rates of untreated patients in 25 randomized clinical trials were 10% to 72% and 8% to 50%, respectively.
Unlike most patients with solid tumors, prognosis of HCC patients is affected not only by the tumor stage at presentation but also by the underlying liver function. The following are main prognostic factors for HCC patients:
- Anatomic extension of the tumor (i.e., tumor size, number of nodules, presence of vascular invasion, and extrahepatic spread).
- Performance status.
- Functional hepatic reserve based on a Child-Pugh score.[29,30,31]
Other PDQ summaries containing information related to adult primary liver cancer include the following:
- Childhood Liver Cancer
- Liver (Hepatocellular) Cancer Screening
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