Repeat treatment for recurrent hepatocellular carcinoma: is it validated?
- 288 Downloads
Hepatocellular carcinoma (HCC) usually recurs repeatedly and locoregional treatment is attempted unless liver function has deteriorated. This study was aimed to evaluate the effect of repeated treatment on patient prognosis.
The HCC recurrence pattern and types of treatment for recurrence after hepatic resection were reviewed in 134 patients. The effects of repeated treatment on prognosis were evaluated. Univariate and multivariate analyses were performed to determine the prognostic predictors after initial recurrence.
Median number of treatments after recurrence was 3 (range, 0–12). Transarterial chemoembolization was the most common treatment. The number of treatments, but not the type of treatment, was associated with the prognosis. Multivariate analysis showed that a >20% indocyanine green retention rate at 15 min (hazard ratio [HR] = 2.65; 95% confidential interval [CI], 1.53–5.62), size of primary tumor >5 cm (HR = 1.81; 95% CI, 1.05–3.08), recurrence-free interval <1 year (HR = 2.17; 95% CI, 1.28–3.81), size of recurrent tumor >3 cm (HR = 2.61; 95% CI, 1.03–5.77–0.95), and extrahepatic recurrence (HR = 6.35; 95% CI, 3.49–11.39) were independent predictors of poor survival.
The prognosis after recurrence is poor in cases with large tumors or poor liver function. Repeated locoregional treatment contributes to prolong patient prognosis, especially in cases with a small tumor size, long recurrence-free interval, and no extrahepatic metastases.
KeywordsHepatocellular carcinoma Recurrence Repeat locoregional treatment Prognostic predictors
Conflicts of interest
- 7.Poon RT, Ngan H, Lo CM, Liu CL, Fan ST, Wong J (2000) Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol 73:109–114. doi: 10.1002/(SICI)1096-9098(200002)73:2<109::AID-JSO10>3.0.CO;2-J PubMedCrossRefGoogle Scholar
- 8.Yang W, Chen MH, Yin SS, Yan K, Gao W, Wang YB, Huo L, Zhang XP, Xing BC (2006) Radiofrequency ablation of recurrent hepatocellular carcinoma after hepatectomy: therapeutic efficacy on early- and late-phase recurrence. AJR Am J Roentgenol 186:S275–S283. doi: 10.2214/AJR.04.1573 PubMedCrossRefGoogle Scholar
- 9.Taura K, Ikai I, Hatano E, Fujii H, Uyama N, Shimahara Y (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. doi: 10.1097/01.sla.0000217921.28563 PubMedCrossRefGoogle Scholar
- 11.Okuwaki Y, Nakazawa T, Kokubu S, Hidaka H, Tanaka Y, Takada J, Watanabe M, Shibuya A, Minamino T, Saigenji K (2009) Repeat radiofrequency ablation provides survival benefit in patients with intrahepatic distant recurrence of hepatocellular carcinoma. Am J Gastroenterol 104:2747–2753PubMedCrossRefGoogle Scholar
- 13.Couinaud C (1957) Le foie: études anatomiques et chirugicales. Masson, ParisGoogle Scholar
- 18.Takayasu K, Arii S, Ikai I, Omata M, Okita K, Ichida T, Matsuyama Y, Nakanuma Y, Kojiro M, Makuuchi M, Yamaoka Y (2006) Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 131:461–469. doi: 10.1053/j.gastro.2006.05.021 PubMedCrossRefGoogle Scholar
- 21.Ren ZG, Lin ZY, Xia JL, Ye SL, Ma ZC, Ye QH, Qin LX, Wu ZQ, Fan J, Tang ZY (2004) Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor: a retrospective control study. World J Gastroenterol 10:2791–2794PubMedGoogle Scholar
- 23.Zhong C, Guo RP, Li JQ, Shi M, Wei W, Chen MS, Zhang YQ (2009) A randomized controlled trial of hepatectomy with adjuvant transcatheter arterial chemoembolization versus hepatectomy alone for stage III A hepatocellular carcinoma. J Cancer Res Clin Oncol 135:1437–1445. doi: 10.1007/s00432-009-0588-2 PubMedCrossRefGoogle Scholar
- 24.Ernst O, Sergent G, Mizrahi D, Delemazure O, Paris JC, L’Hermine C (1999) Treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization: comparison of planned periodic chemoembolization and chemoembolization based on tumor response. AJR Am J Roentgenol 172:59–64PubMedGoogle Scholar
- 26.Shimada K, Sakamoto Y, Esaki M, Kosuge T, Morizane C, Ikeda M, Ueno H, Okusaka T, Arai Y, Takayasu K (2007) Analysis of prognostic factors affecting survival after initial recurrence and treatment efficacy for recurrence in patients undergoing potentially curative hepatectomy for hepatocellular carcinoma. Ann Surg Oncol 14:2337–2347. doi: 10.1245/s10434-007-9415-7 PubMedCrossRefGoogle Scholar
- 27.Matsuda M, Fujii H, Kono H, Matsumoto Y (2001) Surgical treatment of recurrent hepatocellular carcinoma based on the mode of recurrence: repeat hepatic resection or ablation are good choices for patients with recurrent multicentric cancer. J Hepatobiliary Pancreat Surg 8:353–359. doi: 10.1007/s0053410080353 PubMedCrossRefGoogle Scholar
- 31.Yang Y, Nagano H, Ota H, Morimoto O, Nakamura M, Wada H, Noda T, Damdinsuren B, Marubashi S, Miyamoto A, Takeda Y, Dono K, Umeshita K, Nakamori S, Wakasa K, Sakon M, Monden M (2007) Patterns and clinicopathologic features of extrahepatic recurrence of hepatocellular carcinoma after curative resection. Surgery 141:196–202. doi: 10.1016/j.surg.2006.06.033 PubMedCrossRefGoogle Scholar