Diffuse infiltrative hepatocellular carcinomas in a hepatitis B-endemic area: Diagnostic and therapeutic impediments

Background/Aims: Clinical features of diffuse infiltrative hepatocellular carcinoma (D-HCC) are distinct from those of mass-forming HCCs, and also dependent on etiologic viruses. Moreover, despite a regular HCC-surveillance in those with chronic liver diseases, patients sometimes present with advanced D-HCCs. Thus, in the present study, we were to assess the risk factors, mode of diagnosis and prognosis of D-HCCs in a hepatitis B virus-endemic area. Methodology. From January to June 2003, 35 patients who had been newly diagnosed as having D-HCC were enrolled. Their clinical characteristics were compared with those with other types of HCCs, who had been enrolled during the same period. Survival rates were analyzed using Kaplan-Meier method and Cox proportional hazard model. Results: D-HCC patients were younger and more commonly positive for HBsAg than those with other types of HCCs. During a regular follow-up, these tumors were not readily detectable in ultrasonography. Transarterial chemoembolization was beneficial in patients with good liver function as compared to supportive care, while this was not evident in those with poor hepatic reserve. Conclusions: D-HCCs are not readily diagnosed using ultrasonography. These tumors are mostly resistant to treatment, while transarterial chemoembolization might be applied in patients with good liver function.