Role of Operative Therapy in Non-cirrhotic Patients with Metastatic Hepatocellular Carcinoma
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We investigated the role of operative therapy in non-cirrhotic patients who developed metastatic hepatocellular carcinoma (HCC).
This retrospective cohort study included consecutive non-cirrhotic patients with metastatic HCC after a prior hepatectomy treated between 1990 and 2009. Patients were stratified by operative therapy (resection, ablation, transcatheter therapy). Kaplan–Meier analyses with log-rank comparisons tested effects of operative therapy on overall survival (OS) and progression-free survival (PFS).
Of 195 non-cirrhotic patients treated for HCC during the study period, 98 [median age 65, interquartile range (IQR) 53–71; 55 % male] subsequently developed metastatic HCC (55 intrahepatic only). Median time to development of metastases after the index operation was 10 months (IQR 5–20 months); median number of metastases was 3 (IQR 2–7). Half of these patients (n = 50) underwent operative treatment of metastases; 20 (40 %) underwent metastasectomy, 18 (36 %) ablation, and 12 (24 %) transcatheter therapy. Operative therapy was associated with improved OS (p < 0.001). Resection or ablation was associated with improved PFS and OS compared to transcatheter therapy (all p ≤ 0.006). Nine patients (seven resection, two ablation) are disease free at a median of 50 months (IQR 24–80 months) posttreatment.
Resection and ablation are associated with an improved PFS and long-term OS and should be considered in select patients with metastatic HCC.
- Benson AB, 3rd, Abrams TA, Ben-Josef E, et al. NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw 2009;7:350–91.
- Jung SM, Jang JW, You CR, et al. Role of intrahepatic tumor control in the prognosis of patients with hepatocellular carcinoma and extrahepatic metastases. J Gastroenterol Hepatol 2012; 27:684–89. CrossRef
- Chua TC, Morris DL. Exploring the role of resection of extrahepatic metastases from hepatocellular carcinoma. Surg Oncol 2011 (published ahead of print date; doi:10.1016/j.suronc.2011.01.005).
- Leong TY, Leong AS. Epidemiology and carcinogenesis of hepatocellular carcinoma. HPB (Oxford) 2005;7:5–15. CrossRef
- Sherman M. Hepatocellular carcinoma: epidemiology, surveillance, and diagnosis. Semin Liver Dis 2010;30:3–16. CrossRef
- Jarnagin W, Chapman WC, Curley S, et al. Surgical treatment of hepatocellular carcinoma: expert consensus statement. HPB (Oxford) 2010;12:302–10.
- Smoot RL, Nagorney DM, Chandan VS, et al. Resection of hepatocellular carcinoma in patients without cirrhosis. Br J Surg 2011;98:697–703. CrossRef
- Shrager B, Jibara G, Schwartz M, Roayaie S. Resection of Hepatocellular Carcinoma Without Cirrhosis. Ann Surg 2012 (published ahead of print date; doi:10.1097/SLA.0b013e31823e70a3).
- Cha C, Fong Y, Jarnagin WR, Blumgart LH, DeMatteo RP. Predictors and patterns of recurrence after resection of hepatocellular carcinoma. J Am Coll Surg 2003;197:753–8. CrossRef
- Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 2003;37:429–42. CrossRef
- Nowak AK, Chow PK, Findlay M. Systemic therapy for advanced hepatocellular carcinoma: a review. Eur J Cancer 2004;40:1474–84. CrossRef
- Samuel M, Chow PK, Chan Shih-Yen E, Machin D, Soo KC. Neoadjuvant and adjuvant therapy for surgical resection of hepatocellular carcinoma. Cochrane Database Syst Rev 2009:CD001199.
- Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008;359:378–90. CrossRef
- Hirokawa F, Hayashi M, Miyamoto Y, et al. Appropriate treatment strategy for intrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma. J Gastrointest Surg 2011;15:1182–7. CrossRef
- Kwon JB, Park K, Kim YD, et al. Clinical outcome after pulmonary metastasectomy from primary hepatocellular carcinoma: analysis of prognostic factors. World J Gastroenterol 2008;14:5717–22. CrossRef
- Yoon YS, Kim HK, Kim J, et al. Long-term survival and prognostic factors after pulmonary metastasectomy in hepatocellular carcinoma. Ann Surg Oncol 2010;17:2795–801. CrossRef
- Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual. Seventh ed. New York: Springer; 2010.
- Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–81.
- Wallenstein S, Zucker CL, Fleiss JL. Some statistical methods useful in circulation research. Circ Res 1980;47:1–9. CrossRef
- Zhu AX. Systemic treatment of hepatocellular carcinoma: dawn of a new era? Ann Surg Oncol 2010;17:1247–56. CrossRef
- Llovet JM, Bruix J. Molecular targeted therapies in hepatocellular carcinoma. Hepatology 2008;48:1312–27. CrossRef
- Villanueva A, Minguez B, Forner A, Reig M, Llovet JM. Hepatocellular carcinoma: novel molecular approaches for diagnosis, prognosis, and therapy. Annu Rev Med 2010;61:317–28. CrossRef
- Sieghart W, Pinter M, Reisegger M, et al. Conventional transarterial chemoembolisation in combination with sorafenib for patients with hepatocellular carcinoma: a pilot study. Eur Radiol 2012 (published ahead of print date; doi:10/1007/s00330-011-2368-z).
- Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 1999;229:216–22. CrossRef
- Farges O, Regimbeau JM, Belghiti J. Aggressive management of recurrence following surgical resection of hepatocellular carcinoma. Hepatogastroenterology 1998;45 Suppl 3:1275–80.
- Poon RT, Fan ST, Wong J. Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg 2000;232:10–24. CrossRef
- Ho CM, Lee PH, Shau WY, Ho MC, Wu YM, Hu RH. Survival in patients with recurrent hepatocellular carcinoma after primary hepatectomy: Comparative effectiveness of treatment modalities. Surgery 2012;151:700–09. CrossRef
- Sakamoto Y, Kubota K, Mori M, et al. Surgical management for adrenal gland metastasis of hepatocellular carcinoma. Hepatogastroenterology 1999;46:1036–41.
- Nakayama H, Takayama T, Makuuchi M, et al. Resection of peritoneal metastases from hepatocellular carcinoma. Hepatogastroenterology 1999;46:1049–52.
- Gordon-Weeks AN, Snaith A, Petrinic T, Friend PJ, Burls A, Silva MA. Systematic review of outcome of downstaging hepatocellular cancer before liver transplantation in patients outside the Milan criteria. Br J Surg 2011;98:1201–8. CrossRef
- Davis E, Wiesner R, Valdecasas J, Kita Y, Rossi M, Schwartz M. Treatment of recurrent hepatocellular carcinoma after liver transplantation. Liver Transpl 2011;17 Suppl 2:S162–6. CrossRef
- Role of Operative Therapy in Non-cirrhotic Patients with Metastatic Hepatocellular Carcinoma
Journal of Gastrointestinal Surgery
Volume 16, Issue 8 , pp 1516-1523
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