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Repeat treatment for recurrent hepatocellular carcinoma: is it validated?

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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References

  1. Arii S, Teramoto K, Kawamura T, Okamoto H, Kaido T, Mori A, Imamura M (2001) Characteristics of recurrent hepatocellular carcinoma in Japan and our surgical experience. J Hepatobiliary Pancreat Surg 8:397–403

    Article  PubMed  CAS  Google Scholar 

  2. Shimada M, Takenaka K, Gion T, Fujiwara Y, Kajiyama K, Maeda T, Shirabe K, Nishizaki T, Yanaga K, Sugimachi K (1996) Prognosis of recurrent hepatocellular carcinoma: a 10-year surgical experience in Japan. Gastroenterology 111:720–726

    Article  PubMed  CAS  Google Scholar 

  3. 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 229:216–222

    Article  PubMed  CAS  Google Scholar 

  4. 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 192:339–344

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  6. Itamoto T, Nakahara H, Amano H, Kohashi T, Ohdan H, Tashiro H, Asahara T (2007) Repeat hepatectomy for recurrent hepatocellular carcinoma. Surgery 141:589–597. doi:10.1016/j.surg.2006.12.014

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google 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

    Article  PubMed  Google 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

    Article  PubMed  Google Scholar 

  10. Choi D, Lim HK, Rhim H, Kim YS, Yoo BC, Paik SW, Joh JW, Park CK (2007) Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: long-term results and prognostic factors. Ann Surg Oncol 14:2319–2329. doi:10.1245/s10434-006-9220-8

    Article  PubMed  Google 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 104:2747–2753

    Article  PubMed  Google Scholar 

  12. Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T (1995) Criteria for safe hepatic resection. Am J Surg 169:589–594

    Article  PubMed  CAS  Google Scholar 

  13. Couinaud C (1957) Le foie: études anatomiques et chirugicales. Masson, Paris

    Google Scholar 

  14. Shimada M, Takenaka K, Taguchi K, Fujiwara Y, Gion T, Kajiyama K, Maeda T, Shirabe K, Yanaga K, Sugimachi K (1998) Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg 227:80–85

    Article  PubMed  CAS  Google Scholar 

  15. Chen WT, Chau GY, Lui WY, Tsay SH, King KL, Loong CC, Wu CW (2004) Recurrent hepatocellular carcinoma after hepatic resection: prognostic factors and long-term outcome. Eur J Surg Oncol 30:414–420. doi:10.1016/j.ejso.2004.01

    PubMed  Google Scholar 

  16. Choi GH, Kim DH, Kang CM, Kim KS, Choi JS, Lee WJ, Kim BR (2008) Prognostic factors and optimal treatment strategy for intrahepatic nodular recurrence after curative resection of hepatocellular carcinoma. Ann Surg Oncol 15:618–629. doi:10.1245/s10434-007-9671-6

    Article  PubMed  Google Scholar 

  17. Kawano Y, Sasaki A, Kai S, Endo Y, Iwaki K, Uchida H, Shibata K, Ohta M, Kitano S (2009) Prognosis of patients with intrahepatic recurrence after hepatic resection for hepatocellular carcinoma: a retrospective study. Eur J Surg Oncol 35:174–179

    PubMed  CAS  Google 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

    Article  PubMed  CAS  Google Scholar 

  19. Izumi R, Shimizu K, Iyobe T, Ii T, Yagi M, Matsui O, Nonomura A, Miyazaki I (1994) Postoperative adjuvant hepatic arterial infusion of Lipiodol containing anticancer drugs in patients with hepatocellular carcinoma. Hepatology 20:295–301

    Article  PubMed  CAS  Google Scholar 

  20. Cheng HY, Wang X, Chen D, Xu AM, Jia YC (2005) The value and limitation of transcatheter arterial chemoembolization in preventing recurrence of resected hepatocellular carcinoma. World J Gastroenterol 11:3644–3646

    PubMed  Google 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 10:2791–2794

    PubMed  Google Scholar 

  22. Peng BG, He Q, Li JP, Zhou F (2009) Adjuvant transcatheter arterial chemoembolization improves efficacy of hepatectomy for patients with hepatocellular carcinoma and portal vein tumor thrombus. Am J Surg 198:313–318. doi:10.1016/j.amjsurg.2008.09.026

    Article  PubMed  Google 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

    Article  PubMed  Google 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 172:59–64

    PubMed  CAS  Google Scholar 

  25. Poon RT, Fan ST, O’Suilleabhain CB, Wong J (2002) Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma by combined resection and locoregional therapy. J Am Coll Surg 195:311–318

    Article  PubMed  Google 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

    Article  PubMed  Google 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

    Article  PubMed  CAS  Google Scholar 

  28. Shirabe K, Kanematsu T, Matsumata T, Adachi E, Akazawa K, Sugimachi K (1991) Factors linked to early recurrence of small hepatocellular carcinoma after hepatectomy: univariate and multivariate analyses. Hepatology 14:802–805

    Article  PubMed  CAS  Google Scholar 

  29. 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 89:500–507. doi:10.1002/1097-0142(20000801)89

    Article  PubMed  CAS  Google Scholar 

  30. Shah SA, Greig PD, Gallinger S, Cattral MS, Dixon E, Kim RD, Taylor BR, Grant DR, Vollmer CM (2006) Factors associated with early recurrence after resection for hepatocellular carcinoma and outcomes. J Am Coll Surg 202:275–283. doi:10.1016/j.jamcollsurg.2005.10.005

    Article  PubMed  Google 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

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8500, Japan

    Yoji Kishi, Akio Saiura, Rintaro Koga, Makoto Seki, Ryo Morimura, Ryuji Yoshioka & Toshiharu Yamaguchi

  2. Department of Hepato-Biliary-Pancreatic Surgery, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan

    Junji Yamamoto

  3. Department of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Norihiro Kokudo

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  1. Yoji Kishi
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  2. Akio Saiura
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Correspondence to Yoji Kishi.

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Kishi, Y., Saiura, A., Yamamoto, J. et al. Repeat treatment for recurrent hepatocellular carcinoma: is it validated?. Langenbecks Arch Surg 396, 1093–1100 (2011). https://doi.org/10.1007/s00423-011-0837-0

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  • DOI: https://doi.org/10.1007/s00423-011-0837-0

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