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Clinical Features of Hepatocellular Carcinoma Developing Extrahepatic Recurrences After Curative Resection

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Abstract

Background

Few details of the clinical features of hepatocellular carcinoma (HCC) developing extrahepatic recurrence after a curative resection have been published. The purpose of this study was to clarify the clinicopathologic findings of patients with HCC who experienced extrahepatic metastases.

Methods

Clinicopathologic data were available for 119 patients who underwent an R0 resection for HCC. Twenty-three patients who developed extrahepatic metastases during the follow-up period were compared with the patients who remained free from recurrence for at least 5 years after resection (n = 21) or with only intrahepatic recurrences (n = 75).

Results

Patients with extrahepatic recurrences were more likely to have their tumor macro- or microscopically invading the tumor capsule (P < 0.001) and hepatic vein (P = 0.003), a high AFP concentration (P = 0.014), and advanced TNM stage (P = 0.006) than the other patients. As for treatment-related variables, inflow vessel occlusion during hepatectomy was less frequently associated with extrahepatic recurrences than if it were not performed (P < 0.001). By multivariate analysis, absence of tumor invasion to the capsule (relative risk [RR] = 0.080; P = 0.023) or to the hepatic vein (RR = 0.108; P = 0.014) and a hepatectomy in which inflow vessel occlusions were performed (RR = 0.161; P = 0.004) were selected as independent factors for reducing extrahepatic recurrences after a hepatectomy.

Conclusion

In HCC patients, the control of intrahepatic recurrences and extrahepatic recurrences after a hepatectomy is important to improve the prognosis. Inflow occlusion during the hepatectomy may reduce HCC metastases to extrahepatic sites.

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Abbreviations

AFP:

α-fetoprotein

CH:

Chronic hepatitis

CT:

Computed tomography

HbsAg:

anti-HB surface antigen

HbcAb:

anti-HB core antibody

HCVAb:

Hepatitis C virus antibody

HCC:

Hepatocellular carcinoma

Hx:

Hepatectomy

ICGR15:

Indocyanine green retention rate at 15 min

LC:

Liver cirrhosis

Moderate:

Moderately differentiated hepatocellular carcinoma

NBNC:

Non-B viral non-C viral

NL:

Normal liver

Poor:

Poorly differentiated hepatocellular carcinoma

PS:

Prediction score

PT-INR:

Prothrombin time as the International Normalized Ratio

Well:

Welldifferentiated hepatocellular carcinoma

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Kuniya Tanaka, Hiroshi Shimada, Kenichi Matsuo, Kazuhisa Takeda, Yasuhiko Nagano & Shinji Togo

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  1. Kuniya Tanaka
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  2. Hiroshi Shimada
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  3. Kenichi Matsuo
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  4. Kazuhisa Takeda
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  5. Yasuhiko Nagano
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  6. Shinji Togo
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Correspondence to Kuniya Tanaka.

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Tanaka, K., Shimada, H., Matsuo, K. et al. Clinical Features of Hepatocellular Carcinoma Developing Extrahepatic Recurrences After Curative Resection. World J Surg 32, 1738–1747 (2008). https://doi.org/10.1007/s00268-008-9613-x

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