In view of the recent progress in the diagnosis of HCC in its early stage by such means as AFP and celiac angiography, making surgery a hopeful reality, a study comparing gross pathology and angiograms is desirable. The described classification which is based on the combination of two parameters, namely, the presence or absence of cirrhosis in the nontumorous portion (A-C) and the mode of growth (I-TV), may be of value in this regard. This classification may also prove useful in the study of the characteristic vascular changes, because expansive growth besonders capsule formation have an important effect on tumor vessels.

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Based on the registered autopsy cases since 1958, the association of hepatocellular carcinoma with cirrhotic changes was studied on the 275, 857 autopsy cases carried out in Japan during 16 years from 1958 to 1973.1.The incidence of hepatocellular carcinoma among autopsies has been fairly high compared with Western countries, amounting 2.5 percent (3.5 percent in male and 1.2 percent in female).2.The incidence of cirrhotic changes among these autopsies was 6.3 percent in male and 4.3 percent in female. Presumably, the majority of cirrhosis in Japan is of multilobular thin septal pattern, which has been popularly called as B type cirrhosis of Nagayo-Miyake's classification or posthepatitic type of Gall's classification.3.The association of hepatocellular carcinoma with cirrhotic changes is found as 70.0 percent in male and 53.3 percent in female (66.8 percent in total). On the other hand, cirrhotic changes, particularly those above mentioned, are closely associated with hepatocellular carcinoma, and it was found that 23.3 percent of cirrhotic changes (27.2 percent in male and 12.9 percent in female) were associated with hepatocellular carcinoma.4.Cholangiocellular carcinoma is also asociated with cirrhosis to the less extent than hepatocellular carcinoma (20.7 percent in male and 10.7 percent in female), and cirrhotic changes are not associated with cholangiocellular carcinoma.5.Age incidences of hepatocellular carcinoma, B type cirrhosis and cirrhosis NOS are presented. The peaks are at 55 years old, 60 and 60 respectively.

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We are coming in a stage where efforts are being directed toward the detection of small resectable HCC before the secondaries have developed. To that end, AFP alone is not as dependable as once thought when this test became available. Close clinical follow-up of patients with chronic hepatitis and cirrhosis with regular intervals for AFP is imperative. Consistently and mildly abnormal AFP levels should arouse suspicion and more sophisticated diagnostic means are to be sought, such as celiac angiography, laparoscopy and scintiscanning. Tumor specific immunological tests are to be developed to reinforce the diagnostic armamentarium for early detection of HCC.

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Portal branch ligation, a new surgical treatment for unresectable carcinoma of the liver, was performed in twenty patients. All the patients tolerated the procedure, and morbidity and mortality were minimal, even in patients in poor general condition. The responses to ligation differed considerably, but significant palliation was attained in some patients and one survivied six years. The effect of portal branch ligation on the tumor appears to be closely related to the degree of tumor vascularity, tumor malignancy and portal circulatory disturbances such as cirrhosis, portal hypertension, or portal thrombosis. We believe that the present procedure can be recommended for clinical application in some patients with unresectable carcinoma of the liver.

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