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A Prognostic Model and Treatment Strategy for Intrahepatic Recurrence of Hepatocellular Carcinoma after Curative Resection

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Abstract

Background

The aim of this study was to evaluate the prognostic factors for intrahepatic recurrence of hepatocellular carcinoma (HCC) after curative resection.

Methods

Of 297 patients with HCC who underwent curative resection between 1998 and 2007, 145 had intrahepatic recurrence, and 125 of these were enrolled in this study. We analyzed the relationships between overall survival after HCC recurrence and 20 variables at initial hepatectomy and recurrence.

Results

Recurrent HCC was treated by repeat hepatectomy (Re-Hr, n = 29), radiofrequency ablation (RFA, n = 58), or transarterial chemoembolization (TAE, n = 38). Complete tumor control (CTC) by Re–He and RFA was selected for 70% of patients. RFA-treated patients had more tumors, smaller tumors, and poorer liver function at recurrence than the Re-Hr group. The overall 1-, 3-, and 5-year post-recurrence survival rates (SR) were 93.1, 66.8, 58.1%; 94.7, 75.1, 48.3%; and 80.1, 22.5, 0%, respectively, in the Re-Hr, RFA, and TAE groups. The SR was better for Re-Hr and RFA than for TAE (p < 0.0001). Outcomes were similar in Re-Hr and RFA, regardless of recurrent tumor size. Multivariate analysis identified Child-Pugh grade B, AFP ≥100 ng/ml at recurrence, recurrent tumor size ≥3 cm, tumor number ≥3, and CTC as significant prognostic factors for overall post-recurrence survival. A scoring system using 1 point for each patient-background factor provided a well-categorized predictive model. The overall 3-/5-year post-recurrence SRs were 83.1/59.3%, 64.1/41.9%, 42.0/18.0%, and 13.6/0% at risk number (R) R0, R1, R2, and R3/4, respectively (p < 0.05).

Conclusions

Significant prognostic factors for intrahepatic recurrent HCC are poor hepatic reserve, AFP, recurrent tumor size and number, and CTC. Selection of treatment modality for intrahepatic recurrence requires the clinician to be mindful of the predictive factors and to control tumors aggressively by adequate treatment, selected by balancing various conditions.

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References

  1. Parkin DM, Bray F, Ferlay J et al (2001) Estimating the world cancer burden: GLOBOCAN 2000. Int J Cancer 94:153–156

    Article  CAS  PubMed  Google Scholar 

  2. Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917

    Article  PubMed  Google Scholar 

  3. Hasegawa K, Kokudo N, Imamura H et al (2005) Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 242:252–259

    Article  PubMed  Google Scholar 

  4. Fan ST, Lo CM, Liu CL et al (1999) Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 229:322–330

    Article  CAS  PubMed  Google Scholar 

  5. Torzilli G, Makuuchi M, Inoue K et al (1999) No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. Arch Surg 134:984–992

    Article  CAS  PubMed  Google Scholar 

  6. Imamura H, Matsuyama Y, Miyagawa Y et al (1999) Prognostic significance of anatomical resection and des-γ-carboxy prothrombin in patients with hepatocellular carcinoma. Br J Surg 86:1032–1038

    Article  CAS  PubMed  Google Scholar 

  7. Belghiti J, Panis Y, Farges O et al (1990) Intrahepatic recurrence of hepatocellular carcinoma complicating cirrhosis. Ann Surg 214:114–117

    Article  Google Scholar 

  8. Fan ST, Ng IOL, Poon RT et al (1999) Hepatectomy for hepatocellular carcinoma: the surgeon’s role in long-term survival. Arch Surg 134:1124–1130

    Article  CAS  PubMed  Google Scholar 

  9. Matsuda Y, Ito T, Oguchi Y et al (1993) Rationale of surgical management for recurrent hepatocellular carcinoma. Ann Surg 217:28–34

    Article  CAS  PubMed  Google Scholar 

  10. Shimada M, Takenaka K, Taguchi K et al (1998) Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg 227:80–85

    Article  CAS  PubMed  Google Scholar 

  11. Hu RH, Lee CS, Lee PH et al (1996) Surgical resection for recurrent hepatocellular carcinoma: prognosis and analysis of risk factors. Surgery 120:23–29

    Article  CAS  PubMed  Google Scholar 

  12. Chen MS, Li JQ, Zheng Y et al (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243:321–328

    Article  PubMed  Google Scholar 

  13. Lü MD, Kuang M, Liang LJ et al (2006) Surgical resection versus percutaneous thermal ablation for early-stage hepatocellular carcinoma: a randomized clinical trial. Zhonghua Yi Xue Za Zhi 86:801–805

    PubMed  Google Scholar 

  14. Guglielmi A, Ruzzenente A, Valdegamberi A et al (2008) Radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma in cirrhosis. J Gastrointest Surg 12:192–198

    Article  PubMed  Google Scholar 

  15. Taura K, Ikai I, Hatano E et al (2006) Implication of frequent local ablation therapy for intrahepatic recurrence in prolonged survival of patients with hepatocellular carcinoma undergoing hepatic resection: an analysis of 610 patients over 16 years old. Ann Surg 244:265–273

    Article  PubMed  Google Scholar 

  16. Choi D, Lim HK, Rhim H et al (2007) Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: long-term results and prognostic factors. Ann Surg Oncol 14:2319–2329

    Article  PubMed  Google Scholar 

  17. Yin XY, Xie XY, Lu MD et al (2005) Percutaneous thermal ablation for recurrent hepatocellular carcinoma after hepatectomy. Br J Surg 92:1393–1398

    Article  PubMed  Google Scholar 

  18. Liver Cancer Study Group of Japan (2003) General rules for the clinical and pathological study of primary liver cancer, 2nd English edn. Kanehara, Tokyo [The 2000 4th Japanese edition corresponds to the 2003 2nd English edition]

  19. Sadamori H, Yagi T, Matsukawa H et al (2008) Successful re-transection of conglutinated hepatic resection plane for repeated systematized hepatectomy. Hepatogastroenterology 55:363–366

    PubMed  Google Scholar 

  20. Nouso K, Matsumoto E, Kobayashi Y et al (2008) Risk factors for local and distant recurrence of hepatocellular carcinomas after local ablation therapies. J Gastroenterol Hepatol 23:453–458

    Article  CAS  PubMed  Google Scholar 

  21. Bradburn MJ, Clark TG, Love SB et al (2003) Survival analysis, Part III: multivariate data analysis–choosing a model and assessing its adequacy and fit. Br J Cancer 89:605–611

    Article  CAS  PubMed  Google Scholar 

  22. Poon RT, Fan ST, Lo CM et al (1999) Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 229:216–222

    Article  CAS  PubMed  Google Scholar 

  23. Minagawa M, Makuuchi M, Takayama T et al (2003) Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 238:703–710

    Article  PubMed  Google Scholar 

  24. Tralhão JG, Dagher I, Lino T et al (2007) Treatment of tumour recurrence after resection of hepatocellular carcinoma. Analysis of 97 consecutive patients. Eur J Surg Oncol 33:746–751

    PubMed  Google Scholar 

  25. Sugimachi K, Maehara S, Tanaka S et al (2001) Repeat hepatectomy is the most useful treatment for recurrent hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 8:410–416

    Article  CAS  PubMed  Google Scholar 

  26. Nakajima Y, Ko S, Kanamura T et al (2001) Repeat liver resection for hepatocellular carcinoma. J Am Coll Surg 192:339–344

    Article  CAS  PubMed  Google Scholar 

  27. Neeleman N, Andersson R (1996) Repeated liver resection for recurrent liver cancer. Br J Surg 83:893–901

    Article  CAS  PubMed  Google Scholar 

  28. Lam VW, Ng KK, Chok KS et al (2008) Risk factors and prognostic factors of local recurrence after radiofrequency ablation of hepatocellular carcinoma. J Am Coll Surg 207:20–29

    Article  PubMed  Google Scholar 

  29. Hori T, Nagata K, Hasuike S et al (2003) Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol 38:977–981

    Article  PubMed  Google Scholar 

  30. Harrison LE, Koneru B, Baramipour P et al (2003) Locoregional recurrences are frequent after radiofrequency ablation for hepatocellular carcinoma. J Am Coll Surg 197:759–764

    Article  PubMed  Google Scholar 

  31. Machi J, Uchida S, Sumida K et al (2001) Ultrasound-guided radiofrequency thermal ablation of liver tumors: percutaneous, laparoscopic, and open surgical approaches. J Gastrointest Surg 5:477–489

    Article  CAS  PubMed  Google Scholar 

  32. Bleicher RJ, Allegra DP, Nora DT et al (2003) Radiofrequency ablation in 447 complex unresectable liver tumors: lessons learned. Ann Surg Oncol 10:52–58

    Article  PubMed  Google Scholar 

  33. Kuvshinoff BW, Ota DM (2002) Radiofrequency ablation of liver tumors: influence of technique and tumor size. Surgery 132:605–611 discussion 602–611

    Article  PubMed  Google Scholar 

  34. Komorizono Y, Oketani M, Sako K et al (2003) Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session, single application of percutaneous radiofrequency ablation. Cancer 97:1253–1262

    Article  PubMed  Google Scholar 

  35. Tateishi R, Shiina S, Ohki T et al (2009) Treatment strategy for hepatocellular carcinoma: expanding the indications for radiofrequency ablation. J Gastroenterol 44(Suppl 19):142-146

    Google Scholar 

  36. Chinn SB, Lee FT Jr, Kennedy GD et al (2001) Effect of vascular occlusion on radiofrequency ablation of the liver: results in a porcine model. AJR Am J Roentgenol 176:789–795

    CAS  PubMed  Google Scholar 

  37. Mulier S, Mulier P, Ni Y et al (2002) Complications of radiofrequency coagulation of liver tumours. Br J Surg 89:1206–1222

    Article  CAS  PubMed  Google Scholar 

  38. Kim SH, Lim HK, Choi D et al (2004) Changes in bile ducts after radiofrequency ablation of hepatocellular carcinoma: frequency and clinical significance. AJR Am J Roentgenol 183:1611–1617

    PubMed  Google Scholar 

  39. Akahane M, Koga H, Kato N et al (2005) Complications of percutaneous radiofrequency ablation for hepato-cellular carcinoma: imaging spectrum and management. Radiographics 25:S57–S68

    Article  PubMed  Google Scholar 

  40. Yamasaki T, Kurokawa F, Shirahashi H et al (2002) Percutaneous radiofrequency ablation therapy for patients with hepatocellular carcinoma during occlusion of hepatic blood flow. Comparison with standard percutaneous radiofrequency ablation therapy. Cancer 95:2353–2360

    Article  PubMed  Google Scholar 

  41. Stippel DL, Töx U, Gossmann A et al (2003) Successful treatment of radiofrequency-induced biliary lesions by interventional endoscopic retrograde cholangiography (ERC). Surg Endosc 17:1965–1970

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Transplant, and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama-shi, 700-8558, Okayama, Japan

    Yuzo Umeda, Hiroaki Matsuda, Hiroshi Sadamori, Takahito Yagi & Toshiyoshi Fujiwara

  2. Department of Surgery, Hiroshima City Hospital, Hiroshima, Japan

    Hiroyoshi Matsukawa

Authors
  1. Yuzo Umeda
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  2. Hiroaki Matsuda
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  3. Hiroshi Sadamori
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  4. Hiroyoshi Matsukawa
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  5. Takahito Yagi
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  6. Toshiyoshi Fujiwara
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Correspondence to Yuzo Umeda.

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Umeda, Y., Matsuda, H., Sadamori, H. et al. A Prognostic Model and Treatment Strategy for Intrahepatic Recurrence of Hepatocellular Carcinoma after Curative Resection. World J Surg 35, 170–177 (2011). https://doi.org/10.1007/s00268-010-0794-8

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  • DOI: https://doi.org/10.1007/s00268-010-0794-8

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