Hepatocellular carcinoma (HCC) is the most common liver
tumor in Asian countries, and
hepatectomy is currently regarded as the optimal curative treatment for HCC; however, the postoperative outcome remains unsatisfactory. Aiming at further clarification of prognostic factors after
hepatectomy, we adopted a detailed stratification on survival periods. A total of 428 HCC patients undergoing curative
hepatectomy were firstly divided into two groups using 2-year survival as cutoff point. Multivariate analysis showed that
tumor-related factors, including vascular invasion (P < 0.001), high Edmondson grade (P < 0.001), large
tumor size (P < 0.001) and high serum
alpha-fetoprotein level (P = 0.001), were significant determinants for early death within 2 years, while postoperative transarterial chemoembolization (TACE) was demonstrated a protective factor (P = 0.013). Then the 281 patients with survival > 2 years were divided into two subgroups according to survival or death during follow-up to examine the late death related factors. We found that high serum γ-
glutamyl transpeptidase (GGT), indicating severity of underlying
liver disease, was significantly linked to death in this stage (P = 0.006). In further comparison of survival rates between subgroups stratified by early- and late-death indictors, we found the long-term outcomes of patients with high serum GGT were poor, regardless of the factors related with primary
tumor. Furthermore, postoperative TACE decreased late death rate of patients with high GGT levels. In conclusion, despite the overwhelmed effects of primary
tumor in the early stage after
hepatectomy, postoperative TACE is beneficial for HCC patients with poor liver status.