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Clinical and Translational Oncology

, Volume 18, Issue 8, pp 831–840 | Cite as

Factors affecting the recurrence and survival of hepatocellular carcinoma after hepatectomy: a retrospective study of 601 Chinese patients

  • T. T. Zhang
  • X. Q. Zhao
  • Z. Liu
  • Z. Y. Mao
  • L. BaiEmail author
Research Article

Abstract

Objective

Indications for resection of hepatocellular carcinoma (HCC) remain controversial. This study aimed to identify prognostic factors that affect overall survival (OS) and disease-free survival (DFS) in patients with HCC after hepatectomy.

Methods

From 2004 to 2010, 601 patients with HCC who underwent resection were enrolled. Factors stratified into the host, biochemical, surgical treatment and tumor-related features in terms of recurrence and overall survival were analyzed. Prognostic factors were evaluated by univariate and multivariate analyses, with Kaplan–Meier survival analyses and Cox proportional hazard model.

Results

The overall survival rates of 1-, 3- and 5- year were 79, 62, and 54 %, and the corresponding DFS rates were 51, 38 and 31 %, respectively. In a multivariate analysis, Child–Pugh, serum AFP level, ALT level, time for hepatic resection, tumor differentiation, maximum size of tumors, local necrosis, portal vein tumor thrombus, and TNM Stage were correlated significantly with patients’ OS. Gender (P = 0.046), cigarette smoking (P = 0.007), serum AFP level (P = 0.001), GGT level (P = 0.002), maximum size of tumors (P = 0.009), liver cirrhosis (P = 0.025), portal vein tumor thrombus (P = 0.022), microvascular tumor thrombus (P = 0.007) and TNM Stage (P = 0.001) were significantly affected DFS.

Conclusion

Preoperative AFP level, maximum size of tumors, portal vein tumor thrombus and TNM Stage were revealed as important prognostic factors for OS and DFS through follow-up of a relatively large cohort of Chinese HCC patients.

Keywords

Hepatocellular carcinoma Hepatectomy Patient prognosis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest with respect to this manuscript. No disclosure of commercial interests and financial support.

References

  1. 1.
    Ferenci P, Fried M, Labrecque D, Bruix J, Sherman M, Omata M, et al. Hepatocellular carcinoma (HCC): a global perspective. J Clin Gastroenterol. 2010;44:239–45.CrossRefPubMedGoogle Scholar
  2. 2.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMedGoogle Scholar
  3. 3.
    Kaibori M, Ishizaki M, Saito T, Matsui K, Kwon A, Kamiyama Y. Risk factors and outcome of early recurrence after resection of small hepatocellular carcinomas. Am J Surg. 2009;198:39–45.CrossRefPubMedGoogle Scholar
  4. 4.
    Hashem B. Hepatocellular carcinoma. New Engl J Med. 2011;365:1118–27.CrossRefGoogle Scholar
  5. 5.
    Zhou L, Rui JA, Wang SB, Chen SG and Qu Q. Clinicopathological predictors of poor survival and recurrence after curative resection in hepatocellular carcinoma without portal vein tumor thrombosis. Pathol Oncol Res. 2014:1–8.Google Scholar
  6. 6.
    Andreou A, Vauthey JN, Cherqui D, Zimmitti G, Ribero D, Truty MJ, et al. Improved long-term survival after major resection for hepatocellular carcinoma: a multicenter analysis based on a new definition of major hepatectomy. J Gastrointest Surg. 2013;17:66–77.CrossRefPubMedGoogle Scholar
  7. 7.
    Hu L, Xue F, Li Y, Shao M, Sun Y and Wei G. A long-term follow-up and comprehensive observation of risk and prognosis factors of recurrence and survival after resection of hepatocellular carcinoma. Cell Biochem biophys. 2014:1–11.Google Scholar
  8. 8.
    Wang Y-G, Wang P, Wang B, Fu Z-J, Zhao W-J, Yan S-L. Diabetes Mellitus and poorer prognosis in hepatocellular carcinoma: a systematic review and meta-analysis. PLoS One. 2014;9:e95485.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Liu L, Miao R, Yang H, Lu X, Zhao Y, Mao Y, et al. Prognostic factors after liver resection for hepatocellular carcinoma: a single-center experience from China. Am J Surg. 2012;203:741–50.CrossRefPubMedGoogle Scholar
  10. 10.
    Yi Yamashita, 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;104:292–8.CrossRefGoogle Scholar
  11. 11.
    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;37:452–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Pawlik TM, Delman KA, Vauthey JN, Nagorney DM, Ng IOL, Ikai I, et al. Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transplant. 2005;11:1086–92.CrossRefGoogle Scholar
  13. 13.
    Ishii T, Hatano E, Yasuchika K, Taura K, Seo S and Uemoto S. High risk of lung metastasis after resection of hepatocellular carcinoma more than 7 cm in diameter. Surg Today. 2013:1–6.Google Scholar
  14. 14.
    Eguchi S, Kanematsu T, Arii S, Omata M, Kudo M, Sakamoto M, et al. Recurrence-free survival more than 10 years after liver resection for hepatocellular carcinoma. Brit J Surg. 2011;98:552–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Tandon P, Garcia-Tsao G. Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies. Liver Int. 2009;29:502–10.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Sumie S, Kuromatsu R, Okuda K, Ando E, Takata A, Fukushima N, et al. Microvascular invasion in patients with hepatocellular carcinoma and its predictable clinicopathological factors. Ann Surg Oncol. 2008;15:1375–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Ochiai T, Ikoma H, Okamoto K, Kokuba Y, Sonoyama T, Otsuji E. Clinicopathologic features and risk factors for extrahepatic recurrences of hepatocellular carcinoma after curative resection. World J Surg. 2012;36:136–43.CrossRefPubMedGoogle Scholar
  18. 18.
    Kee K-M, Wang J-H, Lin C-Y, Wang C-C, Cheng Y-F, Lu S-N. Validation of the 7th Edition TNM staging system for hepatocellular carcinoma: an analysis of 8,828 patients in a Single medical center. Dig Dis Sci. 2013;58:2721–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Vitale A, Saracino E, Boccagni P, Brolese A, D’Amico F, Gringeri E, et al. Validation of the BCLC prognostic system in surgical hepatocellular cancer patients. Transplant Proc. 2009;41:1260–3.CrossRefPubMedGoogle Scholar
  20. 20.
    J-f Zhang, Z-j Shu, C-y Xie, Li Q, Jin X-h GuW, et al. Prognosis of unresectable hepatocellular carcinoma: comparison of seven staging systems (TNM, Okuda, BCLC, CLIP, CUPI, JIS, CIS) in a Chinese cohort. PLoS One. 2014;9:e88182.CrossRefGoogle Scholar
  21. 21.
    Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: globocan 2000. Int J Cancer. 2001;94:153–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Fukuda S, Itamoto T, Amano H, Kohashi T, Ohdan H, Tashiro H, et al. Clinicopathologic features of hepatocellular carcinoma patients with compensated cirrhosis surviving more than 10 years after curative hepatectomy. World J Surg. 2007;31:345–52.CrossRefPubMedGoogle Scholar
  23. 23.
    Koh W, Robien K, Wang R, Govindarajan S, Yuan J, Yu M. Smoking as an independent risk factor for hepatocellular carcinoma: the Singapore Chinese health study. Br J Cancer. 2011;105:1430–5.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Shih WL, Chang HC, Liaw YF, Lin SM, Lee SD, Chen PJ, et al. Influences of tobacco and alcohol use on hepatocellular carcinoma survival. Int J Cancer. 2012;131:2612–21.CrossRefPubMedGoogle Scholar
  25. 25.
    Zhang X-F, Wei T, Liu X-M, Liu C, Lv Y. Impact of cigarette smoking on outcome of hepatocellular carcinoma after surgery in patients with hepatitis B. PLoS One. 2014;9:e85077.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Prieto J. Inflammation, HCC and sex: IL-6 in the centre of the triangle. J Hepatol. 2008;48:380–1.CrossRefPubMedGoogle Scholar
  27. 27.
    Altamirano J, Bataller R. Cigarette smoking and chronic liver diseases. Gut. 2010;59:1159–62.CrossRefPubMedGoogle Scholar
  28. 28.
    Giovannucci E, Rimm EB, Ascherio A, Colditz GA, Spiegelman D, Stampfer MJ, et al. Smoking and risk of total and fatal prostate cancer in United States health professionals. Cancer Epidemiol Biomarkers Prev. 1999;8:277–82.PubMedGoogle Scholar
  29. 29.
    Wang Y, Zheng C, Liang B, Zhao H, Qian J, Liang H, et al. Hepatocellular necrosis, apoptosis, and proliferation after transcatheter arterial embolization or chemoembolization in a standardized rabbit model. J Vasc Interv Radiol. 2011;22:1606–12.CrossRefPubMedGoogle Scholar
  30. 30.
    de Graaf W, van den Esschert JW, van Lienden KP, van Gulik TM. Induction of tumor growth after preoperative portal vein embolization: is it a real problem? Ann Surg Oncol. 2009;16:423–30.CrossRefPubMedGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2015

Authors and Affiliations

  • T. T. Zhang
    • 1
  • X. Q. Zhao
    • 2
  • Z. Liu
    • 2
  • Z. Y. Mao
    • 3
  • L. Bai
    • 1
    Email author
  1. 1.Department of OncologyChinese PLA General HospitalBeijingPeople’s Republic of China
  2. 2.Department of Hepatobiliary SurgeryChinese PLA General HospitalBeijingPeople’s Republic of China
  3. 3.Department of OncologyAir Force General Hospital of Chinese PLABeijingPeople’s Republic of China

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