Prognostic Factors After Resection for Hepatocellular Carcinoma in Nonfibrotic or Moderately Fibrotic Liver. A 116-Case European Series

Abstract

The purpose of this study was to identify factors influencing prognosis after resection for hepatocellular carcinoma in the noncirrhotic liver and to measure the impact of moderate fibrosis on presentation and prognosis. A series of 116 primary procedures were performed for hepatocellular carcinoma in the noncirrhotic liver. These cases accounted for 42% of hepatic resections performed for hepatocellular carcinoma during the study period (1987-2005). Seventy-seven cases (58%) occurred in patients with nonfibrotic livers (Metavir score F0). The mean age was 61 years. The sex ratio was 3.5, with a female predominance before 50 years. Hepatitis B virus (HBV) or hepatitis C virus infection was found in 30% of patients. Symptoms were present in 64% of cases. Elevated serum alpha fetoprotein levels were observed in 44% of cases. Procedures involved minor hepatectomy in 40 cases, major hepatectomy in 72 cases, and transplantation in 4 cases. Postoperative mortality was 6% and morbidity was 31%. Complete resection was achieved in 90% of cases. The tumor was isolated in 72% of cases. The mean tumor diameter was 10.6 cm. Vascular invasion was observed in 48% of cases. Hepatocellular carcinoma in the nonfibrotic liver was associated with younger age and female sex, but there was no difference with other hepatocellular carcinoma with regard to histological or prognostic features. With a median follow-up of 79 months, overall survival was 40% for a median of 41 months. Multivariate analysis identified incomplete resection, vascular invasion, and HBV infection as independent factors of poor prognosis. In case of recurrence, repeat resection was feasible in 30% of cases with 69% survival at 5 years. Although hepatocellular carcinoma in the noncirrhotic liver is generally diagnosed at an advanced stage, its resectability remains high. As a result, hepatocellular carcinoma in the noncirrhotic liver accounts for a large proportion of cases in surgical series and has a better prognosis than hepatocellular carcinoma in the cirrhotic liver. Vascular invasion, incomplete resection, and HBV infection are independent factors of poor prognosis.

The toll‐like receptor 2 (TLR2) ‐196 to ‐174 del/ins polymorphism affects viral loads and susceptibility to hepatocellular carcinoma in chronic hepatitis C

“…However, the role of fibrosis concerning pathogenesis of HCC is still discussed controversially. [20][21][22] Our analysis of the functional role of TLR2 -196 to -174 del/ins alleles with respect to TLR2 expression was based on in vitro stimulation studies. However, our in vitro findings are supported by increased TLR2 expression reported for mononuclear cells in the peripheral blood 23 and livers of HCV-infected patients.…”

Incidence of Hepatocellular Carcinoma and Associated Risk Factors in Hepatitis C-Related Advanced Liver Disease

“…While HCC has been reported rarely in patients with chronic hepatitis C in the absence of cirrhosis, the high frequency of HCC among subjects without cirrhosis in the present study was unexpected [6][7][8][9]37 . One possible explanation is under-staging of the baseline liver biopsy resulting from sampling error; however, eight of the 23 patients with HCC who had no cirrhosis at enrollment also had no cirrhosis on follow-up liver biopsy (all 8 patients) or on explant (1 patient).…”

“…Over time, compensated cirrhosis can advance to decompensated cirrhosis terminating in hepatic failure and death. A common cause for liverrelated death among persons with chronic hepatitis C is hepatocellular carcinoma (HCC), occurring predominantly in those with cirrhosis [3][4][5] , but reports have appeared of HCC occurring, although far less commonly, in persons with bridging fibrosis without definite cirrhosis [6][7][8][9][10] . In studies from Asia, the annual incidence of HCC in subjects with hepatitis C-related cirrhosis is reported to be 4-10%, whereas in European studies, the reported annual incidence is 0.5-5% in comparable subjects [11][12][13] .…”

Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

“…Liver Resection [7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Table 1) The articles reviewed for information on partial liver resection for NC-HCC include 2263 patients; the numbers of patients in these series range from 20 to 254. [7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The results of the French multicenter ...…”

“…[7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The results of the French multicenter study, 1 which includes the world's largest series of resections for HCC arising in normal livers (ie, nonfibrotic and noncirrhotic), are discussed separately. The larger studies come from regions with high rates of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections.…”