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Patients with Multiple Hepatocellular Carcinomas Within the UCSF Criteria Have Outcomes After Curative Resection Similar to Patients Within the BCLC Early-Stage Criteria

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Abstract

Background

Surgical strategies for the treatment of multiple hepatocellular carcinomas (HCC) remain controversial. This study compared the prognostic power of the University of California, San Francisco (UCSF) criteria with the Barcelona Clinic Liver Cancer (BCLC) early-stage criteria.

Methods

Clinical and survival data of 162 multiple-HCC patients in Child-Pugh class A who underwent curative resection were retrospectively reviewed. Prognostic risk factors were analyzed using univariate and multivariate analyses.

Results

UCSF criteria were shown to independently predict overall and disease-free survival. In patients within the UCSF criteria, 3-year overall and disease-free survivals were significantly better than in those exceeding the UCSF criteria (68 vs. 34 % and 54 vs. 26 %, respectively; both p < 0.001). There were no significant differences in 3-year overall and disease-free survival between patients within the UCSF criteria but exceeding the BCLC early stage and patients with BCLC early-stage disease (71 vs. 66 %, p = 0.506 and 57 vs. 50 %, p = 0.666, respectively). Tumors within the UCSF criteria were associated with a lower incidence of high-grade tumor (p = 0.009), microvascular invasion (p = 0.005), 3-month death (p = 0.046), prolonged Pringle’s maneuver (p = 0.005), and surgical margin <0.5 cm (p < 0.001) than those exceeding the UCSF criteria. Tumors within the UCSF criteria but exceeding the BCLC early stage had invasiveness and surgical difficulty similar to those within the BCLC early-stage criteria.

Conclusions

Multiple HCC patients within the UCSF criteria benefit from curative resection. Expansion of curative treatment is justified.

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References

  1. Parkin DM (2001) Global cancer statistics in the year 2000. Lancet Oncol 2:533–543

    Article  PubMed  CAS  Google Scholar 

  2. Altekruse SF, McGlynn KA, Reichman ME (2009) Hepatocellular carcinoma incidence, mortality and survival trends in the United States from 1975–2005. J Clin Oncol 27:1485–1491

    Article  PubMed  Google Scholar 

  3. Sun Y, Liang BL, Zhang XH et al (2002) Magnetic resonance imaging manifestation of 500 patients with primary hepatic cell tumor. Chin J Cancer 21:509–513

    Google Scholar 

  4. Ng KK, Vauthey JN, Pawlik TM et al (2005) Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database. Ann Surg Oncol 12:1–10

    Article  Google Scholar 

  5. Jarnagin WR (2010) Management of small hepatocellular carcinoma: a review of transplantation, resection and ablation. Ann Surg Oncol 17:1226–1233

    Article  PubMed  Google Scholar 

  6. Jarnagin WR, Gonen M, Fong Y et al (2002) Improvement in preoperative outcome after hepatic resection: analysis of 1803 consecutive cases over the past decades. Ann Surg 236:397–407

    Article  PubMed  Google Scholar 

  7. Ishizawa T, Hasegawa K, Aoki T et al (2008) Neither multiple tumors nor portal hypertension are surgical contraindications for hepatocellular carcinoma. Gastroenterology 134:1908–1916

    Article  PubMed  Google Scholar 

  8. Torzilli G, Donadon M, Marconi M et al (2008) Hepatectomy for stage B and stage C hepatocellular carcinoma in the Barcelona Clinic Liver Cancer classification: results of a prospective analysis. Arch Surg 143:1082–1090

    Article  PubMed  Google Scholar 

  9. Lin CT, Hsu KF, Chen TW et al (2010) Comparing hepatic resection and transarterial chemoembolization for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma: change for treatment of choice? World J Surg 34:2155–2161. doi:10.1007/s00268-010-0598-x

    Article  PubMed  Google Scholar 

  10. Ho MC, Huang GT, Tsang YM et al (2009) Liver resection improves the survival of patients with multiple hepatocellular carcinoma. Ann Surg Oncol 16:848–855

    Article  PubMed  Google Scholar 

  11. Ho CM, Lee PH, Chen CL et al (2011) Long-term outcomes after resection versus transplantation for hepatocellular carcinoma within UCSF criteria. Ann Surg Oncol 19:826–833

    Article  PubMed  Google Scholar 

  12. Ramacciato G, Mercantini P, Petrucciani N et al (2010) Does surgical resection have a role in the treatment of large or multinodular hepatocellular carcinoma? Am Surg 76:1189–1197

    PubMed  Google Scholar 

  13. Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236

    Article  PubMed  Google Scholar 

  14. Koniaris LG, Levi DM, Pedroso PE et al (2011) Is surgical resection superior to transplantation in the treatment of hepatocellular carcinoma? Ann Surg 254:527–538

    Article  PubMed  Google Scholar 

  15. Facciuto ME, Koneru B, Rocca JP et al (2008) Surgical treatment of hepatocellular carcinoma beyond Milan criteria: results of liver resection, salvage transplantation, and primary liver transplantation. Ann Surg Oncol 15:1383–1391

    Article  PubMed  Google Scholar 

  16. Yao FY, Ferrell L, Bass NM et al (2001) Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 33:1394–1403

    Article  PubMed  CAS  Google Scholar 

  17. Chua TC, Saxena A, Chu F et al (2011) Hepatic resection for transplantable hepatocellular carcinoma for patients within Milan and UCSF criteria. Am J Clin Oncol 35:141–145

    Article  Google Scholar 

  18. Poon RT, Fan ST, Lo CM et al (2007) Difference in tumor invasiveness in cirrhotic patients with hepatocellular carcinoma fulfilling the Milan criteria treated by resection and transplantation. Ann Surg 245:51–58

    Article  PubMed  Google Scholar 

  19. Vivarelli M, Guglielmi A, Ruzzenente A et al (2004) Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver. Ann Surg 240:102–107

    Article  PubMed  Google Scholar 

  20. Torzilli G, Minagawa M, Takayama T et al (1999) Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy. Hepatology 30:889–893

    Article  PubMed  CAS  Google Scholar 

  21. Tanaka K, Shimada H, Matsumoto C et al (2008) Anatomic versus limited nonanatomic resection for solitary hepatocellular carcinoma. Surgery 143:607–615

    Article  PubMed  Google Scholar 

  22. Yang T, Zhang J, Lu JH et al (2011) Risk factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients underlying liver disease. World J Surg 35:2073–2082. doi:10.1007/s00268-011-1161-0

    Article  PubMed  Google Scholar 

  23. Llovet JM, Vilana R, Bru C et al (2001) Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 33:1124–1129

    Article  PubMed  CAS  Google Scholar 

  24. Livraghi T, Solbiati L, Meloni MF et al (2003) Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 226:441–451

    Article  PubMed  Google Scholar 

  25. Huang J, Yan L, Cheng Z et al (2010) A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg 252:903–912

    Article  PubMed  Google Scholar 

  26. Poon RT, Ngan H, Lo CM et al (2000) Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol 73:109–114

    Article  PubMed  CAS  Google Scholar 

  27. Trevisani F, De Notariis S, Rossi C et al (2001) Randomized control trials on chemoembolization for hepatocellular carcinoma: is there room for new studies? J Clin Gastroenterol 32:383–389

    Article  PubMed  CAS  Google Scholar 

  28. Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022

    Article  PubMed  Google Scholar 

  29. Mazzaferro V, Chun YS, Poon RT et al (2008) Liver transplantation for hepatocellular carcinoma. Ann Surg Oncol 15:1001–1007

    Article  PubMed  Google Scholar 

  30. Cucchetti A, Piscaglia F, Grigioni AD et al (2010) Preoperative prediction of hepatocellular carcinoma tumour grade and micro-vascular invasion by means of artificial neural network: a pilot study. J Hepatol 52:880–888

    Article  PubMed  Google Scholar 

  31. Lim KC, Chow PK, Allen JC et al (2011) Microvascular invasion is a better predictor of tumor recurrence and overall survival following surgical resection for hepatocellular carcinoma compared to the Milan criteria. Ann Surg 254:108–113

    Article  PubMed  Google Scholar 

  32. McHugh PP, Gilbert J, Vera S et al (2010) Alpha-fetoprotein and tumor size are associated with microvascular invasion in explanted livers of patients undergoing transplantation with hepatocellular carcinoma. HPB (Oxford) 12:56–61

    Article  Google Scholar 

  33. Portolani N, Coniglio A, Ghidoni S et al (2006) Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg 243:229–235

    Article  PubMed  Google Scholar 

  34. Zhou YM, Sui CJ, Li B et al (2010) Repeat hepatectomy for recurrent hepatocellular carcinoma: a local experience and a systematic review. World J Surg Oncol 8:55–65

    Article  PubMed  Google Scholar 

  35. Roayaie S, Bassi D, Tarchi P et al (2011) Second hepatic resection for recurrent hepatocellular cancer: a western experience. J Hepatol 55:346–350

    Article  PubMed  Google Scholar 

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Conflict of interest

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Authors and Affiliations

  1. Fifth Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225 Changhai Road, Shanghai, 200438, People’s Republic of China

    Wen-Chao Zhao, Ning Yang, Nan Zhu, Hai-Bin Zhang, Yong Fu, Ben-Dong Chen & Guang-Shun Yang

  2. Department of Liver Disease, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225 Changhai Road, Shanghai, 200438, People’s Republic of China

    Hua-Bang Zhou

  3. Department of Surgery, 43rd Hospital of the Chinese People’s Liberation Army, No. 212 Daguan Road, Kunming, 650000, Yunnan Province, People’s Republic of China

    Wen-Ke Cai

Authors
  1. Wen-Chao Zhao
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  2. Ning Yang
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  3. Nan Zhu
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  4. Hai-Bin Zhang
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  5. Yong Fu
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  6. Hua-Bang Zhou
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  7. Wen-Ke Cai
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  8. Ben-Dong Chen
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  9. Guang-Shun Yang
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Corresponding author

Correspondence to Guang-Shun Yang.

Additional information

Wen-Chao Zhao and Ning Yang contributed equally to this work.

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Zhao, WC., Yang, N., Zhu, N. et al. Patients with Multiple Hepatocellular Carcinomas Within the UCSF Criteria Have Outcomes After Curative Resection Similar to Patients Within the BCLC Early-Stage Criteria. World J Surg 36, 1811–1823 (2012). https://doi.org/10.1007/s00268-012-1601-5

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  • DOI: https://doi.org/10.1007/s00268-012-1601-5

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