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Prognostic Impact of Underlying Liver Fibrosis and Cirrhosis After Curative Resection of Hepatocellular Carcinoma

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Abstract

Background

In the case of hepatocellular carcinoma (HCC), underlying liver pathology may not only determine the feasibility of surgery but may also affect the postsurgical outcome. We report our experience after curative liver resection for HCC in patients with normal liver, liver fibrosis, and liver cirrhosis.

Methods

A total of 72 patients after liver resection with curative intention were analyzed. Histopathologic findings of tumor-unaffected liver tissue were used for retrospective classification: group A (normal liver); group B (liver fibrosis); group C (liver cirrhosis). The groups were compared for differences in short-term surgical results, total survival, and recurrence-free survival.

Results

The rate of major complications was 34.7% and did not significantly differ among groups. The overall perioperative mortality rate was 9.7%, with one patient dying in group A and three patients dying in each of the other two groups. Including perioperative mortality, the median overall survival for the whole group was 37.3 months (95% confidence interval 29.3–45.2 months). The respective 1-, 2-, and 5-year survival rates for group A (n = 21) were 86%, 71%, and 50% and for group C (n = 24) 62%, 50%, and 17%. The overall survival of group B (n = 27) was intermediate (log-rank, P = 0.032). The respective recurrence-free survival rates were 76%, 42%, and 20% for group A and 39%, 13%, and 4% for group C, with group B being intermediate (log-rank, P = 0.016).

Conclusions

Our data demonstrate that liver resection in the presence of compensated liver cirrhosis is feasible but associated with a significantly impaired prognosis for overall and recurrence-free survival. The management of cirrhotic patients with compensated liver function and HCC therefore also requires the opportunity for transplantation.

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References

  1. Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics 2002. Cancer J Clin 55:74–108

    Article  Google Scholar 

  2. Bosch FX, Ribes J, Díaz M et al (2004) Primary liver cancer: worldwide incidence and trends. Gastroenterology 127:S5–S16

    Article  PubMed  Google Scholar 

  3. El-Serag HB, Mason AC (1999) Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 340:745–750

    Article  CAS  PubMed  Google Scholar 

  4. Schütte K, Bornschein J, Malfertheiner P (2009) Hepatocellular carcinoma: epidemiological trends and risk factors. Dig Dis 27:80–92

    PubMed  Google Scholar 

  5. Ribes J, Clèries R, Esteban L et al (2008) The influence of alcohol consumption and hepatitis B and C infections on the risk of liver cancer in Europe. J Hepatol 49:233–242

    Article  CAS  PubMed  Google Scholar 

  6. Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917

    Article  PubMed  Google Scholar 

  7. Seitz HK, Stickel F (2006) Risk factors and mechanisms of hepatocarcinogenesis with special emphasis on alcohol and oxidative stress. Biol Chem 387:349–360

    Article  CAS  PubMed  Google Scholar 

  8. Leone N, Rizzetto M (2005) Natural history of hepatitis C virus infection: from chronic hepatitis to cirrhosis, to hepatocellular carcinoma. Minerva Gastroenterol Dietol 51:31–46

    CAS  PubMed  Google Scholar 

  9. Lok AS, Seeff LB, Morgan TR et al (2008) Incidence of hepatocellular carcinoma and associated risk factors in hepatitis C-related advanced liver disease. Gastroenterology 136:138–148

    Article  PubMed  Google Scholar 

  10. Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL conference—European Association for the Study of the Liver. J Hepatol 35:421–430

    Article  CAS  PubMed  Google Scholar 

  11. Marrero JA, Fontana RJ, Fu S et al (2005) Alcohol, tobacco and obesity are synergistic risk factors for hepatocellular carcinoma. J Hepatol 42:218–224

    Article  CAS  PubMed  Google Scholar 

  12. Cunningham SC, Tsai S, Marques HP et al (2009) Management of early hepatocellular carcinoma in patients with well-compensated cirrhosis. Ann Surg Oncol 16:1820–1831

    Article  PubMed  Google Scholar 

  13. Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–699

    Article  CAS  PubMed  Google Scholar 

  14. Shah SA, Cleary SP, Tan JC et al (2007) An analysis of resection vs transplantation for early hepatocellular carcinoma: defining the optimal therapy at a single institution. Ann Surg Oncol 14:2608–2614

    Article  PubMed  Google Scholar 

  15. El-Serag HB (2002) Hepatocellular carcinoma: an epidemiologic view. J Clin Gastroenterol 35:S72–S78

    Article  PubMed  Google Scholar 

  16. El-Serag HB, Mallat DB, Rabeneck L (2005) Management of the single liver nodule in a cirrhotic patient: a decision analysis model. J Clin Gastroenterol 39:152–159

    PubMed  Google Scholar 

  17. Cha CH, Ruo L, Fong Y et al (2003) Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation. Ann Surg 238:315–321

    PubMed  Google Scholar 

  18. Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, Wong J (2004) Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 240:698–708

    PubMed  Google Scholar 

  19. Bismuth H, Majno PE (2000) Hepatobiliary surgery. J Hepatol 32:208–224

    Article  CAS  PubMed  Google Scholar 

  20. Bruix J, Castells A, Bosch J et al (1996) Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology 111:1018–1022

    Article  CAS  PubMed  Google Scholar 

  21. Park YK, Kim BW, Wang HJ et al (2009) Hepatic resection for hepatocellular carcinoma meeting Milan criteria in Child-Turcotte-Pugh class a patients with cirrhosis. Transplant Proc 41:1691–1697

    Article  PubMed  Google Scholar 

  22. Ikai I, Arii S, Kojiro M et al (2004) Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Cancer 101:796–802

    Article  PubMed  Google Scholar 

  23. Wang CC, Iyer SG, Low JK et al (2009) Perioperative factors affecting long-term outcomes of 473 consecutive patients undergoing hepatectomy for hepatocellular carcinoma. Ann Surg Oncol 16:1832–1842

    Article  PubMed  Google Scholar 

  24. Batts KP, Ludwig J (1995) Chronic hepatitis: an update on terminology and reporting. Am J Surg Pathol 19:1409–1417

    Article  CAS  PubMed  Google Scholar 

  25. Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:351–355

    Article  PubMed  Google Scholar 

  26. Strasberg SM, Linehan DC, Hawkins WG (2009) The accordion severity grading system of surgical complications. Ann Surg 250:177–186

    Article  PubMed  Google Scholar 

  27. Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 30:1434–1440

    Article  CAS  PubMed  Google Scholar 

  28. Grazi GL, Ercolani G, Pierangeli F et al (2001) Improved results of liver resection for hepatocellular carcinoma on cirrhosis give the procedure added value. Ann Surg 234:71–78

    Article  CAS  PubMed  Google Scholar 

  29. Cucchetti A, Ercolani G, Vivarelli M et al (2006) Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl 12:966–971

    Article  PubMed  Google Scholar 

  30. Teh SH, Christein J, Donohue J et al (2005) Hepatic resection of hepatocellular carcinoma in patients with cirrhosis: Model of End-Stage Liver Disease (MELD) score predicts perioperative mortality. J Gastrointest Surg 9:1207–1215

    Article  PubMed  Google Scholar 

  31. Otto G, Heuschen U, Hofmann WJ et al (1998) Survival and recurrence after liver transplantation versus liver resection for hepatocellular carcinoma: a retrospective analysis. Ann Surg 227:424–432

    Article  CAS  PubMed  Google Scholar 

  32. Neeff H, Makowiec F, Harder J et al (2009) [Hepatic resection for hepatocellular carcinoma: results and analysis of the current literature]. Zentralbl Chir 134:127–135

    Article  CAS  PubMed  Google Scholar 

  33. Fong Y, Sun RL, Jarnagin W et al (1999) An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 229:790–799

    Article  CAS  PubMed  Google Scholar 

  34. Lai EC, Fan ST, Lo CM et al (1995) Hepatic resection for hepatocellular carcinoma: an audit of 343 patients. Ann Surg 221:291–298

    Article  CAS  PubMed  Google Scholar 

  35. Margarit C, Escartín A, Castells L et al (2005) Resection for hepatocellular carcinoma is a good option in Child-Turcotte-Pugh class A patients with cirrhosis who are eligible for liver transplantation. Liver Transpl 11:1242–1251

    Article  PubMed  Google Scholar 

  36. Dupont-Bierre E, Compagnon P, Raoul JL et al (2005) Resection of hepatocellular carcinoma in noncirrhotic liver: analysis of risk factors for survival. J Am Coll Surg 201:663–670

    Article  PubMed  Google Scholar 

  37. Capussotti L, Muratore A, Amisano M et al (2006) Liver resection for large-size hepatocellular carcinomas in 47 non-cirrhotic patients: no mortality and long-term survival. Hepatogastroenterology 53:768–772

    CAS  PubMed  Google Scholar 

  38. Chang CH, Chau GY, Lui WY et al (2004) Long-term results of hepatic resection for hepatocellular carcinoma originating from the noncirrhotic liver. Arch Surg 139:320–325

    Article  PubMed  Google Scholar 

  39. Lang H, Sotiropoulos GC, Brokalaki EI et al (2007) Survival and recurrence rates after resection for hepatocellular carcinoma in noncirrhotic livers. J Am Coll Surg 205:27–36

    Article  PubMed  Google Scholar 

  40. Lubrano J, Huet E, Tsilividis B et al (2008) Long-term outcome of liver resection for hepatocellular carcinoma in noncirrhotic nonfibrotic liver with no viral hepatitis or alcohol abuse. World J Surg 32:104–109

    Article  PubMed  Google Scholar 

  41. Cucchetti A, Piscaglia F, Caturelli E et al (2009) Comparison of recurrence of hepatocellular carcinoma after resection in patients with cirrhosis to its occurrence in a surveilled cirrhotic population. Ann Surg Oncol 16:413–422

    Article  PubMed  Google Scholar 

  42. Poon RT, Fan ST, Lo CM et al (2002) Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: implications for a strategy of salvage transplantation. Ann Surg 235:373–382

    Article  PubMed  Google Scholar 

  43. Zhou XD, Tang ZY, Yang BH et al (2001) Experience of 1000 patients who underwent hepatectomy for small hepatocellular carcinoma. Cancer 91:1479–1486

    Article  CAS  PubMed  Google Scholar 

  44. Ng KK, Vauthey JN, Pawlik TM et al (2005) International Cooperative Study Group on Hepatocellular Carcinoma. Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database. Ann Surg Oncol 12:364–373

    Article  PubMed  Google Scholar 

  45. Scatton O, Zalinski S, Terris B et al (2008) Hepatocellular carcinoma developed on compensated cirrhosis: resection as a selection tool for liver transplantation. Liver Transpl 14:779–788

    Article  PubMed  Google Scholar 

  46. Belghiti J, Cortes A, Abdalla EK et al (2003) Resection prior to liver transplantation for hepatocellular carcinoma. Ann Surg 238:885–892

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General and Visceral Surgery, University Hospital Muenster, Waldeyerstrasse 1, Muenster, 48149, Germany

    Peter Gassmann, Fabian Schmidt, Wolf Arif Mardin & Norbert Senninger

  2. Comprehensive Cancer Center Muenster, University Hospital Muenster, Muenster, Germany

    Joerg Haier

  3. Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Domagkstrasse 17, Muenster, Germany

    Tilmann Spieker

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  1. Peter Gassmann
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  2. Tilmann Spieker
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Correspondence to Peter Gassmann.

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Gassmann, P., Spieker, T., Haier, J. et al. Prognostic Impact of Underlying Liver Fibrosis and Cirrhosis After Curative Resection of Hepatocellular Carcinoma. World J Surg 34, 2442–2451 (2010). https://doi.org/10.1007/s00268-010-0655-5

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