DIAGNOSIS AND TREATMENT STRATEGY OF MULTICENTRIC HEPATOCELLULAR CARCINOMA-USING MOLECULAR BIOLOGICAL TECHNIQUE

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In this study, we clarified the mode of development of multiple hapatocellular carcinomas (HCC) in order to make a modality of surgical treatments. We analyzed the clonalities of multiple HCC lesions taken from HCC patients with hepatitis B virus infection, who had multiple HCC nodules synchronously or metachronously, by using molecular-biological technique. For the diagnosis of the clonalities of HCCs, we used integration pattern of HBV DNA assessed by Southern blot analysis (SB). One out of 2 patients who were diagnosed as having multicentric (MC) HCCs by histological methods at operation, was confirmed as MC case by clonal analysis. But, SB was not useful for the diagnosis of the clonality of another patient. Only genetic method was useful for the diagnosis of the clonality of the MC patient who had two poorly differentiated HCCs at operation. One patient who had intrahepatic metastasis at operation also confirmed as metastatic (IM) case by SB.One patient, who had recurrent HCCs in the remnant liver 4 years after the operation, was clinically diagnosed as metachronous MC case, but SB revealed that the recurrent HCCs had the same origin as primary 11CC.From these results, we can conclude that the genetic methods are indispensable for the diagnosis of clonalities of HCCs. Our clinical observations also indicated that for longer survival after hepatectomy of 11CC patients, we should choose appropriate treatments based on the mode of development of recurrent HCC.