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| Surgical treatment of fibrolamellar hepatocellular carcinoma: an underestimated malignant tumor? |
| Paulo Herman, Aline Lopes Chagas, Marcos Vinicius Perini, Fabricio Ferreira Coelho, Gilton Marques Fonseca, Venancio Avancini Ferreira Alves, Flair José Carrilho and Ivan Cecconello |
Sao Paulo, Brazil
Author Affiliations: Digestive Surgery Division, Department of Gastroenterology (Herman P, Chagas AL, Perini MV, Coelho FF, Fonseca GM, Carrilho FJ and Cecconello I) and Department of Pathology (Alves VAF), University of São Paulo School of Medicine, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, CEP: 05403-900, Cerqueira Cesar-São Paulo, SP, Brazil
Corresponding Author: Paulo Herman, MD, PhD, Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, CEP: 05403-900, Cerqueira Cesar-São Paulo, SP, Brazil (Tel/Fax: +55-11-26617560; Email: pherman@uol.com.br) |
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Abstract BACKGROUND: Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare disease with an indolent behavior. Its prognosis is better than that of patients with hepatocellular carcinoma. The authors present their experience with resection of FLHCC.
METHODS: Twenty-one patients with FLHCC were treated at our institution between 1990 and 2012. Of these patients, 14 were subjected to resection of the tumor. Patient demographics, medical history, results of imaging studies and laboratory tests, surgical data, and pathologic findings were evaluated.
RESULTS: The median age of the patients at the diagnosis of the tumor was 20 years and 14 patients were female. None of the patients had tumor-associated chronic liver disease or cirrhosis. The mean tumor size was 12.8 cm (range 6-19) and 18 patients had a single liver nodule. Fourteen patients were subjected to hepatectomy and six of them had lymph node metastases resected. Pathologic evaluation revealed that 5 (35.7%) patients had major vascular invasion. Tumor recurrence was seen in 8 patients (66.7%), during a follow-up. The median survival time for patients who were subjected to resection was 36 months. The 5-year overall survival rate and disease free survival rate were 28.0% and 8.5%, respectively. Univariate analysis showed that vascular invasion was the only variable associated with the disease free survival rate.
CONCLUSIONS: Despite an aggressive treatment, patients with FLHCC presented unexpected low survival rates. It seems that an underestimated malignant behavior is attributed to this disease, and that the forms of adjuvant treatment should be urgently evaluated.
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2014, Vol. 13 
