Résumé
BACKGROUND/AIMS: Cases of small hepatocellular carcinoma (HCC) have been increasing with the progress of diagnostic methods . In this study the screening methods for early diagnosis of HCC were re-evaluated, and comparative therapeutic analyses were perfomed. METHODS: A total of 110 patients with small HCC (< 5 cm and < 4 nodules ) were retrospectively analyzed. The patients were divided into four treatment groups ; unt reated group (No T x, n=12), transarterial-oily-chemoembolization group (TOCE, n=43), combined treatment group of percutaneous ethanol injection and TOCE (CEI, n=22), OP group ( OP, n=33). RESULTS: Small HCC occupied 22.6% of total HCC cases. Only one third of small HCC cases were detected during the regular screening. In this group, Alpha-fet oprotein as say provided a diagnostic clue in 50% of cases, ultras onography in 71%, and the combination of both in 88%. Five year survival rate and 5-year non-recurrence rate in small HCC was 29% and 37% respectively. Comparative therapeutic analys es showed t hat CEI and OP gave a better survival than TOCE in Child grade A. CEI prolonged survival in Child grade B wher eas TOCE did not. Only TOCE was tried and did not improve the survival in Child grade C. CONCLUSION: 1) A more strict screening is needed in high risk group of HCC. 2) As a first line of treatment in small HCC, OP or CEI can be selected in Child grade A, and CEI in Child grade B. In Child grade C, a less invasive treatment (PEIT , microwave coagulat ion therapy) should be investigated.