Posted online on October 27, 2003 on www.jco.org .Read the Study Hepatocellular carcinoma, also known as hepatoma, or cancer of the liver, is a common cancer worldwide, with nearly one million new diagnoses reported each year. Often, patients with hepatoma have underlying cirrhosis, a risk factor for hepatoma. Most patients with advanced disease cannot be operated on because of the location, size or severity of the tumor(s) in the liver.As a result, liver transplants are a possible treatment for patients with advanced disease.In the first national study to examine survival among liver transplant patients with advanced hepatoma, researchers at Johns Hopkins University School of Medicine found that more patients are living for at least five years following diagnosis, with a steady improvement in survival over the last decade. Researchers note that these findings are particularly reassuring for patients with tumors that cannot be surgically removed, who make up more than 80% of hepatoma patients.Using a national database, researchers compared patients who had liver transplants because of hepatoma to patients who had liver transplants for other reasons. Both groups were divided into three different five-year time periods: 1987-1991, 1992-1996, and 1997-2001.Researchers found significant and steady improvement in survival as time progressed among the patients with hepatoma, particularly in the last five years. Five-year survival improved from 25% during 1987-2001 to 61% during 1997-2001.In addition, researchers wanted to see whether guidelines for selecting hepatoma patients for liver transplantation had any indirect impact on patient survival between 1997 and 2001. These guidelines, developed in 1996, recommended that liver transplants be restricted to patients who were most likely to benefit. As a result, many transplant centers have incorporated the guidelines into their practices.Although it cannot be confirmed, researchers believe that the increasing survival among hepatoma patients may be a result of careful selection of patients - or, those who would benefit most from a liver transplant - based on the recommended guidelines.What Does This Mean For Patients?This study suggests that liver transplantation is the treatment of choice in patients with advanced cirrhosis and hepatoma (HCC). Patients with hepatoma should talk to their doctor about potential treatment options, including surgical removal of tumors and liver transplantation. In addition, patients with cirrhosis of the liver should talk to their doctor about closely monitoring for tumors to prevent the development and spread of liver cancer.