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Prognostic Factors and Survival Outcomes of Surgical Resection of Huge Hepatocellular Carcinomas

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Abstract

Introduction

The aim of the study was to analyze the various prognostic factors that influence survival and clinical outcomes in patients undergoing liver resection for huge hepatocellular carcinomas.

Materials and Methods

The records of patients who underwent curative surgery between 1991 and 2011 for huge hepatocellular carcinoma were analyzed. Various prognostic factors that influenced the survival were studied. The patients were followed up till November 2016.

Results

The number of patients who underwent liver resection with huge hepatocellular carcinoma during the study period was 17; this included 14 males and 3 females. The median age of the study population was 52 years. The median serum AFP in the study population was 132.3 ng/ml (range 2 to 187,000 ng/ml). 41.2% of the patients were hepatitis B positive. The overall morbidity was 6%. The mortality rate was nil. The mean size of the resected specimen was 13.9 cm ± 3.6 cm. The overall recurrence rate was 76.5%. The local recurrence rate was 29.4%. The median time to recurrence was 8 months. The 5-year disease-free survival and overall survival of the study group were 26% and 32%, respectively. The factors that predicted an adverse survival outcome after the log-rank test for univariate analysis using life-table method were presence of lymphovascular invasion (p = 0.047), age ≤ 55 years (p = 0.021), and raised serum AFP (p = 0.041).

Conclusion

The factors that predict an adverse outcome after surgery in patients with huge hepatocellular carcinomas were the presence of lymphovascular invasion, raised serum AFP, and age ≤ 55 years.

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References

  1. Poon RT, Fan ST, Wong J. Selection criteria for hepatic resection in patients with large hepatocellular carcinoma larger than 10 cm in diameter. J Am Coll Surg. 2002;194(5):592–602.

    Article  PubMed  Google Scholar 

  2. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693–9.

    CAS  PubMed  Google Scholar 

  3. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33(6):1394–403.

    Article  CAS  PubMed  Google Scholar 

  4. Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10(1):35–43. https://doi.org/10.1016/S1470-2045(08)70284-5.

    Article  PubMed  Google Scholar 

  5. Shirabe K, Shimada M, Gion T, Hasegawa H, Takenaka K, Utsunomiya T, et al. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg. 1999;188(3):304–9.

    Article  CAS  PubMed  Google Scholar 

  6. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4. https://doi.org/10.1245/s10434-010-0985-4.

    Article  PubMed  Google Scholar 

  7. Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646–9. https://doi.org/10.1002/bjs.1800600817.

    Article  CAS  PubMed  Google Scholar 

  8. Zhu S-L, Chen J, Li H, Li L-Q, Zhong J-H. Efficacy of hepatic resection for huge (≥ 10 cm) hepatocellular carcinoma: good prognosis associated with the uninodular subtype. Int J Clin Exp Med. 2015;8(11):20581–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Liver Cancer Study Group of Japan. Predictive factors for longterm prognosis after partial hepatectomy for patients with hepatocellular carcinoma in Japan. Cancer. 1994;74:2772–6.

    Article  Google Scholar 

  10. Huang YH, Wu JC, Chen SC, Chen CH, Chiang JH, Huo T, et al. Survival benefit of transcatheter arterial chemoembolization in patients with hepatocellular carcinoma larger than 10 cm in diameter. Aliment Pharmacol Ther. 2006;23(1):129–35.

    Article  PubMed  Google Scholar 

  11. Poon RT, Ngan H, Lo CM, Liu CL, Fan ST, Wong J. Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol. 2000;73(2):109–14.

    Article  CAS  PubMed  Google Scholar 

  12. Min YW, Lee JH, Gwak GY, Paik YH, Lee JH, Rhee PL, et al. Long-term survival after surgical resection for huge hepatocellular carcinoma: comparison with transarterial chemoembolization after propensity score matching. J Gastroenterol Hepatol. 2014;29(5):1043–8. https://doi.org/10.1111/jgh.12504.

    Article  PubMed  Google Scholar 

  13. Pandey D, Lee KH, Wai CT, Wagholikar G, Tan KC. Long term outcome and prognostic factors for large hepatocellular carcinoma (10 cm or more) after surgical resection. Ann Surg Oncol. 2007;14(10):2817–23.

    Article  PubMed  Google Scholar 

  14. Allemann P, Demartines N, Bouzourene H, Tempia A, Halkic N. Long-term outcome after liver resection for hepatocellular carcinoma larger than 10 cm. World J Surg. 2013;37(2):452–8. https://doi.org/10.1007/s00268-012-1840-5.

    Article  PubMed  Google Scholar 

  15. Liau KH, Ruo L, Shia J, Padela A, Gonen M, Jarnagin WR, et al. Outcome of partial hepatectomy for large (> 10 cm) hepatocellular carcinoma. Cancer. 2005;104(9):1948–55.

    Article  PubMed  Google Scholar 

  16. Goh BK, Kam JH, Lee SY, Chan CY, Allen JC, Jeyaraj P, et al. Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and prognostic nutrition index as preoperative predictors of early mortality after liver resection for huge (≥10 cm) hepatocellular carcinoma. J Surg Oncol. 2016;113(6):621–7. https://doi.org/10.1002/jso.24197.

    Article  CAS  PubMed  Google Scholar 

  17. Hanazaki K, Kajikawa S, Shimozawa N, Shimada K, Hiraguri M, Koide N, et al. Hepatic resection for large hepatocellular carcinoma. Am J Surg. 2001;181(4):347–53.

    Article  CAS  PubMed  Google Scholar 

  18. Jiwei H, Roberto H, Kristopher PC, Yong Z, Hong W, Zheyu C. Hepatic resection for huge (>15 cm) multinodular HCC with macrovascular invasion. J Surg Res. 2012;178(2):743–50. https://doi.org/10.1016/j.jss.2012.04.058.

    Article  Google Scholar 

  19. Chang YJ, Chung KP, Chang YJ, Chen LJ. Long-term survival of patients undergoing liver resection for very large hepatocellular carcinomas. Br J Surg. 2016;103(11):1513–20. https://doi.org/10.1002/bjs.10196.

    Article  CAS  PubMed  Google Scholar 

  20. Yang J, Li C, Wen TF, Yan LN, Li B, Wang WT, et al. Is hepatectomy for huge hepatocellular carcinoma (≥ 10 cm in diameter) safe and effective? A single-center experience. Asian Pac J Cancer Prev. 2014;15(17):7069–77.

    Article  PubMed  Google Scholar 

  21. Lee NH, Chau GY, Lui WY, King KL, Tsay SH, Wu CW. Surgical treatment and outcome in patients with a hepatocellular carcinoma greater than 10 cm in diameter. Br J Surg. 1998;85(12):1654–7.

    Article  CAS  PubMed  Google Scholar 

  22. Zhu Q, Qiao GL, Xu C, Guo DL, Tang J, Duan R, et al. Partial hepatectomy for spontaneous tumor rupture in patients with hepatocellular carcinoma: a retrospective cohort study. Cancer Manag Res. 2017;9:525–37. https://doi.org/10.2147/CMAR.S146708 eCollection 2017.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Tung-Ping Poon R, Fan ST, Wong J. Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg. 2000;232(1):10–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Hwang S, Lee YJ, Kim KH, Ahn CS, Moon DB, Ha TY, et al. Long-term outcome after resection of huge hepatocellular carcinoma ≥ 10 cm: single-institution experience with 471 patients. World J Surg. 2015;39(10):2519–28. https://doi.org/10.1007/s00268-015-3129-y.

    Article  PubMed  Google Scholar 

  25. Zhang W, Tan Y, Jiang L, Yan L, Li B, Wen T, et al. Liver resection associated with better outcomes for single large hepatocellular carcinoma located in the same section. Medicine (Baltimore). 2017;96(10):e6246. https://doi.org/10.1097/MD.0000000000006246.

    Article  Google Scholar 

  26. Yamashita Y, Taketomi A, Shirabe K, Aishima S, Tsuijita E, Morita K, et al. Outcomes of hepatic resection for huge hepatocellular carcinoma (≥ 10 cm in diameter). J Surg Oncol. 2011;104(3):292–8. https://doi.org/10.1002/jso.21931.

    Article  PubMed  Google Scholar 

  27. Choi GH, Han DH, Kim DH, Choi SB, Kang CM, Kim KS, et al. Outcome after curative resection for a huge (>or=10 cm) hepatocellular carcinoma and prognostic significance of gross tumor classification. Am J Surg. 2009;198(5):693–701. https://doi.org/10.1016/j.amjsurg.2008.09.019.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, India

    Jayanand Sunil Bhanu & Ramakrishnan Ayloor Seshadri

  2. Division of GI & HPB Oncology, Department of Surgical Oncology, Cancer Institute (WIA), No.38, Sardar Patel Road, Guindy, Chennai, 600036, India

    Jayanand Sunil Bhanu

  3. Department of Surgical Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, India

    Balasubramanian Venkitaraman

  4. Department of Surgical Oncology, Sri Venkateshwaraa Medical College, Puducherry, India

    Ravisankar Palaniappan

  5. Department of Biostatistics, Cancer Institute (WIA), Adyar, Chennai, India

    Rama Ranganathan

  6. Madras Cancer Care Foundation, Chennai, India

    Vikash Mahajan

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  1. Jayanand Sunil Bhanu
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  2. Balasubramanian Venkitaraman
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  3. Ravisankar Palaniappan
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All authors are responsible for the conception and design of work/acquisition, analysis, and interpretation of data, and drafting and revision of the manuscript. They approved the final version and agreed on all aspects of the work.

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Correspondence to Jayanand Sunil Bhanu.

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Bhanu, J.S., Venkitaraman, B., Palaniappan, R. et al. Prognostic Factors and Survival Outcomes of Surgical Resection of Huge Hepatocellular Carcinomas. J Gastrointest Canc 51, 250–253 (2020). https://doi.org/10.1007/s12029-019-00240-x

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  • DOI: https://doi.org/10.1007/s12029-019-00240-x

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