Hepatic Resection Associated With Good Survival for Selected Patients With Intermediate and Advanced-Stage Hepatocellular Carcinoma

Abstract

Our clinical and literature analyses suggest that in patients with HCC with preserved liver function, the presence of large, solitary tumors, multinodular tumors, macrovascular invasion, or PHT are not contraindications for HR.

Portal hypertension should not be a contraindication of hepatic resection to treat hepatocellular carcinoma with compensated cirrhosis

“…Our retrospective analysis further showed that long-term survival of HCC patients with PH was higher after HR than after transarterial chemoembolization. 4 In fact, such patients showed higher median overall and disease-free survival at 1, 3, and 5 years after HR than did those with multinodular HCC or HCC involving macrovascular invasion. 2 Retrospective subgroup analysis of our patients showed that short-and long-term overall survival was similar in the presence or absence of PHT if the patients had early-stage HCC or had undergone only minor hepatectomy, or if propensity score matching was used to eliminate baseline differences.…”

“…Regression of retrospective data collection is also at risk of suboptimal strength, and propensity score analysis may just delete from the cohort those individuals with an outlier profile that is captured by that use of the parameter that is aimed to be tested, as is the case for portal hypertension in the prediction of prognosis in patients considered for surgical resection. Furthermore, in the absence of a direct measurement of portal pressure in their study, 4 their definition of portal hypertension may have overestimated its presence and prompted a flaw. In their study, 20% of the patients were registered as portal hypertensive because of esophageal varices, but did not have splenomegaly and low platelet count.…”

“…A systematic literature search as well as retrospective study of more than 1,700 patients treated at our medical center between 2007 and 2010 revealed that median perioperative mortality during HR in HCC patients with PH is 6.7%. 2,3 A previous retrospective study of more than 1,200 patients treated at our medical center between 2000 and 2007 found a median perioperative mortality of 10.3%, 4 suggesting that improvements in surgical technique and perioperative care are lowering the mortality associated with HR. Our retrospective analysis further showed that long-term survival of HCC patients with PH was higher after HR than after transarterial chemoembolization.…”

“…In their study, 20% of the patients were registered as portal hypertensive because of esophageal varices, but did not have splenomegaly and low platelet count. 4 This combination is uncommon; we wonder whether, in their retrospective analysis, the registration of varices may indeed be a false positive of endoscopy that could have been performed elsewhere. This misclassification would benefit the high-risk subgroup.…”

Feasibility of combining adjuvant transarterial chemoembolization with nucleos(t)ide analog therapy for patients with HBV-associated hepatocellular carcinoma after hepatectomy

“…Hepatitis B virus (HBV) infection is a well-documented risk factor for hepatocarcinogenesis, and ~90% of patients with HCC in China have chronic HBV infection and concomitant reduced liver function (2,3). Therefore, the prognosis of patients with HBV-associated HCC depends on both tumor status and HBV activity.…”