Risk factors of post-operative recurrence and adequate surgical approach to improve long-term outcomes of hepatocellular carcinoma.

Abstract

INTRODUCTION:

A high recurrence rate of hepatocellular carcinoma (HCC) remains a significant concern. The risk factors for recurrence were analysed and the optimal surgical approaches were investigated.

METHODS:

The subjects comprised 280 consecutive patients with primary solitary HCC measuring ≤5 cm in diameter, who underwent curative resections. Multivariate analysis was conducted to identify the risk factors for post-operative recurrence, and the clinical significance of an anatomic resection was evaluated.

RESULTS:

Multivariate analysis identified HCV infection, a des-gamma-carboxyprothrombin level >100 mAU/ml, underlying cirrhosis, the presence of microvascular invasion, the presence of micrometastases and non-anatomic resection as being significant risk factors for post-operative recurrence. The 5-year recurrence rate was 56.7% in the anatomic resection (AR) group and 74.7% in the non-AR group. The 5-year survival rate was 82.2% in the AR group and 71.9% in the non-AR group. Local recurrence within the same segment was observed in 25% of the patients of the non-AR group. The prognostic superiority of AR was confirmed only in patients with histopathological evidence of microvascular invasion and/or micrometastases, and in patients having a solitary HCC measuring 2 to 5 cm in diameter.

CONCLUSIONS:

Anatomic resection may decrease local recurrence and improve the surgical outcomes in solitary HCC measuring 2 to 5 cm in diameter.

• Authors: Junichi Shindoh, Kiyoshi Hasegawa, Yosuke Inoue, Takeaki Ishizawa, Rihito Nagata, Taku Aoki, Yoshihiro Sakamoto, Yasuhiko Sugawara, Masatoshi Makuuchi, Norihiro Kokudo
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 15 Issue 1 Pg. 31-9 (Jan 2013) ISSN: 1477-2574 [Electronic] England
• PMID: 23216777 (Publication Type: Journal Article)
• Copyright: © 2012 International Hepato-Pancreato-Biliary Association.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular (mortality, pathology, surgery)
• Chi-Square Distribution
• Female
• Hepatectomy (adverse effects, mortality)
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms (mortality, pathology, surgery)
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Recurrence, Local (mortality, pathology, prevention & control)
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome
• Tumor Burden
• Young Adult