The prognostic factor for outcome following second resection for intrahepatic recurrence of hepatocellular carcinoma with a hepatitis B virus infection background

  • Hui-Chuan Sun
  • Zhao-You Tang
  • Zeng-Chen Ma
  • Lun-Xiu Qin
  • Lu Wang
  • Qin-Hai Ye
  • Jia Fan
  • Zhi-Quan Wu
  • Xin-Da Zhou
Original Paper

Abstract

Purpose

Second resection has been proved to be a safe and effective treatment for patients with intrahepatic recurrent HCC after primary resection; however, preoperative prognostic factors for outcome following second resection in patients with a hepatitis B virus (HBV) infection background remains to be clarified.

Methods

Fifty-seven patients with intrahepatic recurrent an HCC and HBV infection background received second resection from 1997 to 2003 in our institute. All of them were negative for anti-hepatitis C virus (HCV) and positive regarding HBV profile. Patient and tumor factors were analyzed.

Results

At the time of preparing this paper, 31 had re-recurrence and 21patients had died. No postoperative mortality was noted. The 1-, 3-, and 5-year overall survival after second resection were 69.9%, 61.2%, and 30.6%, respectively. Univariate and multivariate analysis showed that vascular invasion and time to recurrence were the independent prognostic factors for overall survival following second resection. The 3- and 4-year overall survival after second resection were 57.7% and 46.6% in patients with the presence of any of two risk factors (n=46), and 100% and 100% in those with absence of both risk factors (n=11, P=0.008).

Conclusions

Vascular invasion and time to recurrence were the prognostic factors for overall survival following second resection of intrahepatic recurrent HCC.

Keywords

Hepatocellular carcinoma Recurrence Second resection 

References

  1. Arii S, Monden K, Niwano M, Furutani M, Mori A, Mizumoto M, Imamura M (1998) Results of surgical treatment for recurrent hepatocellular carcinoma; comparison of outcome among patients with multicentric carcinogenesis intrahepatic metastasis and extrahepatic recurrence. J Hepatobiliary Pancreat Surg 5:86–92Google Scholar
  2. Cha C, Fong Y, Jarnagin WR, Blumgart LH, DeMatteo RP (2003) Predictors and patterns of recurrence after resection of hepatocellular carcinoma. J Am Coll Surg 197:753–758CrossRefGoogle Scholar
  3. Cieslak E, Kepka L, Fijuth J, Marchel A, Kroh H (2004) Very late relapse of medulloblastoma. Folia Neuropathol 42:49–53Google Scholar
  4. De Carlis L, Giacomoni A, Pirotta V, Lauterio A, Slim AO, Sammartino C, Cardillo M, Forti D (2003) Surgical treatment of hepatocellular cancer in the era of hepatic transplantation. J Am Coll Surg 196:887–897CrossRefGoogle Scholar
  5. Esnaola NF, Mirza N, Lauwers GY, Ikai I, Regimbeau JM, Belghiti J, Yamaoka Y, Curley SA, Ellis LM, Nagorney DM, Vauthey JN (2003) Comparison of clinicopathologic characteristics and outcomes after resection in patients with hepatocellular carcinoma treated in the United States France and Japan. Ann Surg 238:711–719CrossRefGoogle Scholar
  6. Gattelli A, Cirio MC, Quaglino A, Schere-Levy C, Martinez N, Binaghi M, Meiss RP, Castilla LH, Kordon EC (2004) Progression of pregnancy-dependent mouse mammary tumors after long dormancy periods. Involvement of Wnt pathway activation. Cancer Res 64:5193–5199Google Scholar
  7. Hanazaki K, Kajikawa S, Shimozawa N, Mihara M, Shimada K, Hiraguri M, Koide N, Adachi W, Amano J (2000) Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma. J Am Coll Surg 191:381–388CrossRefPubMedGoogle Scholar
  8. Harrison LE, Koneru B, Baramipour P, Fisher A, Barone A, Wilson D, Dela Torre A, Cho KC, Contractor D, Korogodsky M (2003) Locoregional recurrences are frequent after radiofrequency ablation for hepatocellular carcinoma. J Am Coll Surg 197:759–764CrossRefGoogle Scholar
  9. Hirohashi K, Shuto T, Kubo S, Tanaka H, Yamamoto T, Ikebe T, Murase J, Kinoshita H (2001) Prognostic factors after recurrence of resected hepatocellular carcinoma associated with hepatitis C virus. J Hepatobiliary Pancreat Surg 8:81–86CrossRefGoogle Scholar
  10. Ikeda K, Arase Y, Saitoh S, Kobayashi M, Suzuki Y, Suzuki F, Tsubota A, Chayama K, Murashima N, Kumada H (2000) Interferon beta prevents recurrence of hepatocellular carcinoma after complete resection or ablation of the primary tumor: a prospective randomized study of hepatitis C virus-related liver cancer. Hepatology 32:228–232CrossRefGoogle Scholar
  11. Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, Sugawara Y, Minagawa M, Takayama T, Kawasaki S, Makuuchi M (2003) Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol 38:200–207CrossRefGoogle Scholar
  12. Ishii H, Okada S, Sato T, Nose H, Okusaka T, Yoshimori M, Takayasu K, Takayama T, Kosuge T, Yamasaki S (1996) Effect of percutaneous ethanol injection for postoperative recurrence of hepatocellular carcinoma in combination with transcatheter arterial embolization. Hepatogastroenterology 43:644–650Google Scholar
  13. Jeng KS, Yang FS, Chiang HJ, Ohta I (1992) Repeat operation for nodular recurrent hepatocellular carcinoma within the cirrhotic liver remnant: a comparison with transcatheter arterial chemoembolization. World J Surg 16:1188–1191Google Scholar
  14. Kubo S, Nishiguchi S, Hirohashi K, Tanaka H, Shuto T, Yamazaki O, Shiomi S, Tamori A, Oka H, Igawa S, et al (2001) Effects of long–term postoperative interferon-alpha therapy on intrahepatic recurrence after resection of hepatitis C virus-related hepatocellular carcinoma. A randomized controlled trial. Ann Intern Med 134:963–967Google Scholar
  15. Kumada T, Nakano S, Takeda I, Sugiyama K, Osada T, Kiriyama S, Sone Y, Toyoda H, Shimada S, Takahashi M, Sassa T (1997) Patterns of recurrence after initial treatment in patients with small hepatocellular carcinoma. Hepatology 25:87–92Google Scholar
  16. Lai EC, Lo CM, Fan ST, Liu CL, Wong J (1998) Postoperative adjuvant chemotherapy after curative resection of hepatocellular carcinoma: a randomized controlled trial. Arch Surg 133:183–188CrossRefGoogle Scholar
  17. Meltzer A (1990) Dormancy and breast cancer. J Surg Oncol 43:181–188Google Scholar
  18. Minagawa M, Makuuchi M, Takayama T, Kokudo N (2003) Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 238:703–710CrossRefGoogle Scholar
  19. Muto Y, Moriwaki H, Ninomiya M, Adachi S, Saito A, Takasaki KT, Tanaka T, Tsurumi K, Okuno M, Tomita E, et al (1996) Prevention of second primary tumors by an acyclic retinoid polyprenoic acid in patients with hepatocellular carcinoma. Hepatoma Prevention Study Group. N Engl J Med 334:1561–1567CrossRefGoogle Scholar
  20. Nagasue N, Kohno H, Hayashi T, Uchida M, Ono T, Yukaya H, Yamanoi A (1996) Repeat hepatectomy for recurrent hepatocellular carcinoma. Br J Surg 83:127–131Google Scholar
  21. Nakajima Y, Ko S, Kanamura T, Nagao M, Kanehiro H, Hisanaga M, Aomatsu Y, Ikeda N, Nakano H (2001) Repeat liver resection for hepatocellular carcinoma. J Am Coll Surg 192:339–344CrossRefGoogle Scholar
  22. Nicoli N, Casaril A, Marchiori L, Mangiante G, Hasheminia AR (2001) Treatment of recurrent hepatocellular carcinoma by radiofrequency thermal ablation. J Hepatobiliary Pancreat Surg 8:417–421CrossRefGoogle Scholar
  23. Okazaki M, Yamasaki S, Ono H, Higashihara H, Koganemaru F, Kimura S, Kuroda Y, Sato S, Ryu K, Ohtsubo T (1993) Chemoembolotherapy for recurrent hepatocellular carcinoma in the residual liver after hepatectomy. Hepatogastroenterology 40:320–323Google Scholar
  24. Poon RT, Fan ST, Lo CM, Liu CL, Wong J (1999) Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 229:216–222CrossRefGoogle Scholar
  25. Poon RT, Fan ST, Ng IO, Lo CM, Liu CL, Wong J (2000) Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer 89:500–507CrossRefPubMedGoogle Scholar
  26. Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM, Wong J (2001) Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 234:63–70CrossRefGoogle Scholar
  27. Poon RT, Fan ST, Lo CM, Liu CL, Wong J (2002a) Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg 235:373–382CrossRefGoogle Scholar
  28. Poon RT, Fan ST, O’Suilleabhain CB, Wong J (2002b) Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma by combined resection and locoregional therapy. J Am Coll Surg 195:311–318CrossRefGoogle Scholar
  29. Sugimachi K, Maehara S, Tanaka S, Shimada M (2001) Repeat hepatectomy is the most useful treatment for recurrent hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 8:410–416CrossRefGoogle Scholar
  30. Takayama T, Sekine T, Makuuchi M, Yamasaki S, Kosuge T, Yamamoto J, Shimada K, Sakamoto M, Hirohashi S, Ohashi Y, Kakizoe T (2000) Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet 356:802–807CrossRefGoogle Scholar
  31. Tang ZY, Yu YQ, Zhou XD (1984) An important approach to prolonging survival further after radical resection of AFP positive hepatocellular carcinoma. J Exp Clin Cancer Res 3:359–366Google Scholar
  32. Tang ZY, Yu YQ, Zhou XD, Ma ZC, Yang R, Lu JZ, Lin ZY, Yang BH (1989) Surgery of small hepatocellular carcinoma. Analysis of 144 cases. Cancer 64:536–541Google Scholar
  33. Tang ZY, Yu YQ, Zhou XD, Ma ZC, Wu ZQ (1998) Progress and prospects in hepatocellular carcinoma surgery. Ann Chir 52:558–563PubMedGoogle Scholar
  34. Wu CC, Ho YZ, Ho WL, Wu TC, Liu TJ, P’Eng F K (1995) Preoperative transcatheter arterial chemoembolization for resectable large hepatocellular carcinoma: a reappraisal. Br J Surg 82:122–126Google Scholar
  35. Yamamoto M, Arii S, Sugahara K, Tobe T (1996) Adjuvant oral chemotherapy to prevent recurrence after curative resection for hepatocellular carcinoma. Br J Surg 83:336–340CrossRefGoogle Scholar
  36. Yang HI, Lu SN, Liaw YF, You SL, Sun CA, Wang LY, Hsiao CK, Chen PJ, Chen DS, Chen CJ (2002) Hepatitis B e antigen and the risk of hepatocellular carcinoma. N Engl J Med 347:168–174CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Hui-Chuan Sun
    • 1
  • Zhao-You Tang
    • 1
  • Zeng-Chen Ma
    • 1
  • Lun-Xiu Qin
    • 1
  • Lu Wang
    • 1
  • Qin-Hai Ye
    • 1
  • Jia Fan
    • 1
  • Zhi-Quan Wu
    • 1
  • Xin-Da Zhou
    • 1
  1. 1.Liver Cancer Institute and Zhong Shan HospitalFudan UniversityShanghaiP.R. China

Personalised recommendations