Primary hepatocellular carcinoma in patients with chronic hepatitis B virus infection.

The paper presents 66 hepatocellular carcinoma (HCC) patients (57 males, 9 females) with chronic hepatitis B virus (HBV) infection in the clinical, diagnostic and therapeutic aspects. In 60 cases, hepatic cirrhosis was the primary hepatic disease, in 5--chronic hepatitis, and in 1--neoplasm developed in morphologically normal liver. Forty out of 66 patients were HBsAg seropositive. In 96% of the cases, anti-HBc antibodies were detected. In 76% of the cases, the infection was subclinical. In all patients, neoplasm was diagnosed in the late, symptomatic stage of the disease. Okuda's classification was used to stage the disease. The following treatment methods were applied: surgical in 5 patients, embolization of hepatic artery with intra-arterial administration of cytostatics in 5, intravenous chemotherapy in 39, interferon alpha in lozenges in 15. In 44 patients, an objective response to treatment (according to WHO criteria) was achieved: in 5 (I and II Okuda's stage)--a complete response (CR) for the period of 0.5-4 years, in 2 (III Okuda's stage)--partial response (PR) with prolonged survival time up to 1 year, in 21--no change (NC). The average survival time of non-treated and treated patients was, respectively: in the I Okuda's stage 2.05 and 9.55 months, in stage II 1.36 and 7.36 months, in III stage 1.15 and 5.05 months. The differences in the average values are statistically significant. Only combined therapy, including both surgical and devascularization methods, applied to HCC patients results in achieving a long-lasting complete remission of the disease. Interferon alpha oral therapy improves the effects of the treatment.

[Hepatocellular carcinoma (CHC) in patients chronically infected with HBV]. / Carcinoma hepatocellulare (CHC) u chorych przewlekle zakazonych HBV.

42 cases of hepatocellular carcinoma (CHC) in patients chronically infected with HBV are presented. These are 37 men and 5 women, aged 12 to 78 years. The underlying disease was liver cirrhosis in 38 cases and chronic active hepatitis in 4. HBV infection was confirmed by the detection of viral markers in serum or/and in liver tissue. 52 percent of patients were HBsAg positive and 92 HBcAg positive. In 64 percent of cases the course of HBV infection had been subclinical before the CHC was revealed. The first signs of neoplasm are not characteristic, as the concomitant liver cirrhosis may well justify them. In all patients the diagnosis of CHC was established with presence when manifest clinical symptoms were present according to advanced lesions in most of cases. For the estimation of the stage of disease, the OKUDA system was used. In 24 patients cytostatic treatment was applied. The liver artery embolisation was performed in two cases. The surgical treatment took place in 2 cases of monolobular tumours. The survival period of the non-treated and treated patients was: in the 1st group 2.5 and 7.7 mths, in the 2nd group 1.5 and 5.2 mths, in 3rd group 1.2 and 1.1 mths, and in the 4th group 1.0 and 2.5 mths, respectively. In the groups 1 and 2 improvement of live comfort, due to Zubrod scale, was obtained. The results presented are the argument for attempts of treatment in patients from the 1st and 2nd groups.