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Prognostic factors of disease-free and overall survival in patients with hepatocellular carcinoma undergoing partial hepatectomy in curative intent

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Abstract

Purpose

Tumor recurrence after liver resection continues to pose a major problem in hepatocellular carcinoma (HCC). Here we aimed to evaluate prognostic markers for disease-free (DFS) and overall survival (OS) in HCC-patients who underwent liver resection in curative intent. Additionally, we investigated the effects of HCC-recurrence in a subgroup of patients.

Methods

Between 2010 and 2016, 111 patients underwent surgical resection for HCC at our institution. A subgroup of 50 patients showed tumor recurrence (n = 50) during follow-up. The associations of DFS and OS with histopathologic characteristics were assessed using univariable and multivariable Cox regression analyses.

Results

Median DFS was 31 months and median OS was 27 months. Milan criteria (p = 0.045), macrovascular invasion (p = 0.044) and UICC tumor stage (p = 0.003) were independently associated with DFS while macrovascular invasion (p = 0.001) and MELD score (p = 0.010) were independently associated with OS. Tumor recurrence did not show an association with OS (p = 0.228). However, patients with HCC-recurrence who underwent repeat-surgical or interventional treatment showed improved OS compared to patients treated with palliative or sorafenib treatment alone (OS 18 months vs. 2 months; p < 0.001).

Conclusion

Tumor recurrence alone is not associated with poor oncological outcome and repeat liver resections as well as local-ablative procedures may help to improve OS in HCC.

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Abbreviations

AFP:

Alpha fetoprotein

ALT:

Alanine aminotransferase

ASA:

American society of anesthesiologists

AST:

Aspartate aminotransferase

BCLC:

Barcelona clinical liver cancer staging system

BMI:

Body mass index

BSC:

Best supportive care

CCI:

Comprehensive complication index

CD:

Clavien-Dindo

cmCT:

Contrast-material enhanced computed tomography

CUSA:

Cavitron ultrasonic surgical aspirator

DFS:

Disease-free survival

ECOG:

Eastern Cooperative Oncology Group

FFP:

Fresh frozen plasma

FLR:

Future liver remnant

GGT:

Gamma glutamyltransferase

HCC:

Hepatocellular carcinoma

HIDA:

Hepato-imino diacetic acid

ICG:

Indocyanine green

INR:

International normalized ratio

IRE:

Irreversible electroporation

LiMAx:

Maximum liver function capacity

MELD:

Model of end stage liver disease

MRI:

Magnetic resonance imaging

MVI:

Macrovascular invasion

MWA:

Microwave ablation

OLT:

Orthotopic liver transplantation

OS:

Overall survival

RFA:

Radiofrequency ablation

RWTH:

Rheinisch-Westfälische Technische Hochschule

SIRT:

Selective internal radiation therapy

TACE:

Transarterial chemoembolization

UH-RWTH:

University Hospital RWTH Aachen

UICC:

Union for international cancer control

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Funding

This research project is supported by the START-Program (no. 136/17) of the Faculty of Medicine, RWTH Aachen and funded by the Excellence Initiative of the German federal and state governments (G:(DE-82) ZUK2-SF-OPSF443).

Author information

Author notes

  1. Georg Lurje and Jan Bednarsch contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

    Georg Lurje, Jan Bednarsch, Zoltan Czigany, Iakovos Amygdalos, Franziska Meister, Wenzel Schöning, Tom Florian Ulmer, Martin Foerster, Cornelis Dejong & Ulf Peter Neumann

  2. Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands

    Cornelis Dejong & Ulf Peter Neumann

Authors
  1. Georg Lurje
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  2. Jan Bednarsch
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  4. Iakovos Amygdalos
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Contributions

All authors contributed significantly to this manuscript and agree with the content. The authors contributed as followed: study conception and design, GL, JB, UPN; acquisition of data, IA, FM, MF; analysis and interpretation of data, GL, JB, ZC, TFU, CHCD; drafting of manuscript, GL, JB, MF; critical revision of manuscript, CHCD, UPN.

Corresponding author

Correspondence to Georg Lurje.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was conducted at the UH-RWTH in accordance with the requirements of the Institutional Review Board of the RWTH-Aachen University. Informed consent was obtained from all individual participants included in the study.

Dr. Lurje reports grants from START Program No. 136/17/Faculty of Medicine (RWTH Aachen University), grants from Excellence Initiative of the German federal and state governments, outside the submitted work. All other authors declare no conflict of interest.

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Lurje, G., Bednarsch, J., Czigany, Z. et al. Prognostic factors of disease-free and overall survival in patients with hepatocellular carcinoma undergoing partial hepatectomy in curative intent. Langenbecks Arch Surg 403, 851–861 (2018). https://doi.org/10.1007/s00423-018-1715-9

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  • DOI: https://doi.org/10.1007/s00423-018-1715-9

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