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Clinicopathological Determinants of Survival After Hepatic Resection of Hepatocellular Carcinoma in 97 Patients—Experience From an Australian Hepatobiliary Unit

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Identification of clinicopathological determinants that predict for risk of recurrence and overall survival after undergoing potentially curative hepatic resection for hepatocellular carcinoma is a strategy towards personalizing therapy to improve outcome. Through evaluation of a center’s experience with treatment of a disease, determinants unique to the treated patient cohort may be identified.

Methods

Ninety-seven patients with hepatocellular carcinoma underwent liver resection. Clinical, treatment, and histopathological variables were collected and evaluated using univariate and multivariate analyses with disease-free survival (DFS) and overall survival (OS) as the endpoints.

Results

The median follow-up period of 19 (range, 1 to 188) months from the time of hepatic resection. The median DFS and OS after resection of HCC were 17 and 41 months, respectively. Five-year overall survival rate was 45%. Eight independent factors associated with disease-free and overall survival were identified through a multivariate analysis. Three factors: Child–Pugh score (DFS p = 0.045, OS p = 0.001), histopathological grade (DFS p < 0.001, OS p < 0.001), and histological diagnosis of cirrhosis (DFS p < 0.001, OS p < 0.001) predicted for both disease-free and overall survival.

Conclusion

Integrating the knowledge of identified prognostic factors into clinical decision making may provide a clinicopathological signature that could identify patients at greatest risk of treatment failure such that novel interventions may be applied to improve the survival outcome.

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References

  1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.

    Article  PubMed  Google Scholar 

  2. Amin J, O'Connell D, Bartlett M, Tracey E, Kaldor J, Law M, et al. Liver cancer and hepatitis B and C in New South Wales, 1990-2002: a linkage study. Aust N Z J Public Health. 2007;31(5):475–82.

    Article  PubMed  Google Scholar 

  3. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med. 1999;340(10):745–50.

    Article  CAS  PubMed  Google Scholar 

  4. Deuffic S, Poynard T, Buffat L, Valleron AJ. Trends in primary liver cancer. Lancet. 1998;351(9097):214–5.

    Article  CAS  PubMed  Google Scholar 

  5. Llovet JM, Bruix J. Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol. 2008;48(Suppl 1):S20–37.

    Article  CAS  PubMed  Google Scholar 

  6. 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.

    Article  CAS  PubMed  Google Scholar 

  7. Nathan H, Schulick RD, Choti MA, Pawlik TM. Predictors of survival after resection of early hepatocellular carcinoma. Ann Surg. 2009;249(5):799–805.

    Article  PubMed  Google Scholar 

  8. Poon RT, Fan ST, Lo CM, Liu CL, Ng IO, Wong J. Long-term prognosis after resection of hepatocellular carcinoma associated with hepatitis B-related cirrhosis. J Clin Oncol. 2000;18(5):1094–101.

    CAS  PubMed  Google Scholar 

  9. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology. 1999;30(6):1434–40.

    Article  CAS  PubMed  Google Scholar 

  10. Wu CC, Ho YZ, Ho WL, Wu TC, Liu TJ, P'Eng FK. Preoperative transcatheter arterial chemoembolization for resectable large hepatocellular carcinoma: a reappraisal. Br J Surg. 1995;82(1):122–6

    Article  CAS  PubMed  Google Scholar 

  11. Yamasaki S, Hasegawa H, Kinoshita H, Furukawa M, Imaoka S, Takasaki K, et al. A prospective randomized trial of the preventive effect of pre-operative transcatheter arterial embolization against recurrence of hepatocellular carcinoma. Jpn J Cancer Res. 1996;87(2):206–11.

    CAS  PubMed  Google Scholar 

  12. Lau WY, Leung TW, Ho SK, Chan M, Machin D, Lau J, et al. Adjuvant intra-arterial iodine-131-labelled lipiodol for resectable hepatocellular carcinoma: a prospective randomised trial. Lancet. 1999;353(9155):797–801.

    Article  CAS  PubMed  Google Scholar 

  13. Lau WY, Lai EC, Leung TW, Yu SC. Adjuvant intra-arterial iodine-131-labeled lipiodol for resectable hepatocellular carcinoma: a prospective randomized trial-update on 5-year and 10-year survival. Ann Surg. 2008;247(1):43–8.

    Article  PubMed  Google Scholar 

  14. Yamamoto M, Arii S, Sugahara K, Tobe T. Adjuvant oral chemotherapy to prevent recurrence after curative resection for hepatocellular carcinoma. Br J Surg. 1996;83(3):336–40.

    Article  CAS  PubMed  Google Scholar 

  15. Ono T, Nagasue N, Kohno H, Hayashi T, Uchida M, Yukaya H, et al. Adjuvant chemotherapy with epirubicin and carmofur after radical resection of hepatocellular carcinoma: a prospective randomized study. Semin Oncol. 1997;24(2 Suppl 6):S6-18–S6-25.

    Google Scholar 

  16. Muto Y, Moriwaki H, Saito A. Prevention of second primary tumors by an acyclic retinoid in patients with hepatocellular carcinoma. N Engl J Med. 1999;340(13):1046–7.

    Article  CAS  PubMed  Google Scholar 

  17. Takayama T, Sekine T, Makuuchi M, Yamasaki S, Kosuge T, Yamamoto J, et al. Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet. 2000;356(9232):802–7.

    Article  CAS  PubMed  Google Scholar 

  18. Minagawa M, Ikai I, Matsuyama Y, Yamaoka Y, Makuuchi M. Staging of hepatocellular carcinoma: assessment of the Japanese TNM and AJCC/UICC TNM systems in a cohort of 13,772 patients in Japan. Ann Surg. 2007;245(6):909–22.

    Article  PubMed  Google Scholar 

  19. Vauthey JN, Lauwers GY, Esnaola NF, Do KA, Belghiti J, Mirza N, et al. Simplified staging for hepatocellular carcinoma. J Clin Oncol. 2002;20(6):1527–36.

    Article  PubMed  Google Scholar 

  20. Katz SC, Shia J, Liau KH, Gonen M, Ruo L, Jarnagin WR, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg. 2009;249(4):617–23.

    Article  PubMed  Google Scholar 

  21. Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, et al. Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol. 2003;38(2):200–7.

    Article  PubMed  Google Scholar 

  22. Ercolani G, Grazi GL, Ravaioli M, Del Gaudio M, Gardini A, Cescon M, et al. Liver resection for hepatocellular carcinoma on cirrhosis: univariate and multivariate analysis of risk factors for intrahepatic recurrence. Ann Surg. 2003;237(4):536–43.

    Article  PubMed  Google Scholar 

  23. Greene FL. The AJCC Cancer Staging Manual. Philadelphia: Lippinscott Raven Publisher; 2002.

    Book  Google Scholar 

  24. Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: The BCLC staging classification. Sem Liv Dis. 1999;19:329–338.

    Article  CAS  Google Scholar 

  25. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatology. 1998;28(3):751–5.

    Article  Google Scholar 

  26. Lencioni R, Cioni D, Crocetti L, Franchini C, Pina CD, Lera J, et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology. 2005;234(3):961–7.

    Article  PubMed  Google Scholar 

  27. Ueno S, Sakoda M, Kubo F, Hiwatashi K, Tateno T, Baba Y, et al. Surgical resection versus radiofrequency ablation for small hepatocellular carcinomas within the Milan criteria. J Hepatobiliary Pancreat Surg. 2009;16(3):359–66.

    Article  PubMed  Google Scholar 

  28. Jonas S, Bechstein WO, Steinmuller T, Herrmann M, Radke C, Berg T, et al. Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology. 2001;33(5):1080–6.

    Article  CAS  PubMed  Google Scholar 

  29. Poon RT, Fan ST, Lo CM, Liu CL, Wong J. 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. 2002;235(3):373–82.

    Article  PubMed  Google Scholar 

  30. Mathew T. The Australian experience in organ donation--2003. Ann Transplant. 2004;9(1):28–30.

    PubMed  Google Scholar 

  31. Kumada T, Nakano S, Takeda I, Sugiyama K, Osada T, Kiriyama S, et al. Patterns of recurrence after initial treatment in patients with small hepatocellular carcinoma. Hepatology. 1997;25(1):87–92.

    Article  CAS  PubMed  Google Scholar 

  32. Zhou XD, Tang ZY, Yang BH, Lin ZY, Ma ZC, Ye SL, et al. Experience of 1000 patients who underwent hepatectomy for small hepatocellular carcinoma. Cancer. 2001;91(8):1479–86.

    Article  CAS  PubMed  Google Scholar 

  33. Kohno H, Nagasue N, Hayashi T, Yamanoi A, Uchida M, Ono T, et al. Postoperative adjuvant chemotherapy after radical hepatic resection for hepatocellular carcinoma (HCC). Hepatogastroenterology. 1996;43(12):1405–9.

    CAS  PubMed  Google Scholar 

  34. Lai EC, Lo CM, Fan ST, Liu CL, Wong J. Postoperative adjuvant chemotherapy after curative resection of hepatocellular carcinoma: a randomized controlled trial. Arch Surg. 1998;133(2):183–8.

    Article  CAS  PubMed  Google Scholar 

  35. Boucher E, Corbinais S, Rolland Y, Bourguet P, Guyader D, Boudjema K, et al. Adjuvant intra-arterial injection of iodine-131-labeled lipiodol after resection of hepatocellular carcinoma. Hepatology. 2003;38(5):1237–41.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of New South Wales Department of Surgery, St George Hospital, Level 3 Pitney Building, Gray Street, Kogarah, Sydney, 2217, NSW, Australia

    Terence C. Chua, Akshat Saxena, Francis Chu, Jing Zhao & David L. Morris

  2. Department of Medical Oncology, Cancer Care Centre, St George Hospital, Kogarah, Sydney, 2217, NSW, Australia

    Winston Liauw

Authors
  1. Terence C. Chua
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  2. Akshat Saxena
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  3. Francis Chu
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  4. Winston Liauw
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  5. Jing Zhao
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  6. David L. Morris
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Correspondence to David L. Morris.

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Chua, T.C., Saxena, A., Chu, F. et al. Clinicopathological Determinants of Survival After Hepatic Resection of Hepatocellular Carcinoma in 97 Patients—Experience From an Australian Hepatobiliary Unit. J Gastrointest Surg 14, 1370–1380 (2010). https://doi.org/10.1007/s11605-010-1277-9

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  • DOI: https://doi.org/10.1007/s11605-010-1277-9

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