Recurrence Patterns and Prognostic Factors in Patients with Hepatocellular Carcinoma in Noncirrhotic Liver: A Multi-Institutional Analysis

Abstract

Background Hepatocellular carcinoma (HCC) primarily affects patients with a cirrhotic liver. Reports on the characteristics of patients with HCC in noncirrhotic liver, as well as predictors of recurrence and survival, are scarce. Methods Between 1992 and 2011, 334 patients treated for HCC in noncirrhotic liver were identified from three major hepatobiliary centers. Clinicopathological characteristics were analyzed and independent predictors of recurrence and overall survival were identified using Cox proportional hazards models. Results Median patient age was 58 years and 77 % were male. Most patients had a solitary (81 %) and poorly or undifferentiated tumor (56 %); median size was 6.5 cm. The majority of patients (96 %) underwent liver resection (microscopically negative margins in 94 %), whereas a few had transarterial chemoembolization or transplantation (4 %). Median recurrence-free survival (RFS) was 2.5 years, and 1- and 5-year RFS was 71.1, and 35 %, respectively. Elevated alkaline phosphatase levels [hazards ratio (HR) = 1.82], poor tumor differentiation (HR = 1.4), macrovascular invasion (HR = 2.18), and the presence of satellite lesions (HR = 1.9), or intrahepatic metastases (HR = 2.59) were independently associated with shorter RFS; in contrast, an intact tumor capsule independently prolonged RFS (HR = 0.46). Median overall survival was 5.9 years, and 1- and 5-year overall survival was 86.9, and 54.5 %, respectively. Tumor size ≥5 cm (HR = 2.27), macrovascular (HR = 2.72) or adjacent organ invasion (HR = 3.34), and satellite lesions (HR = 2.18) were independently associated with shorter overall survival, whereas an intact tumor capsule showed a protective effect (HR = 0.51). Conclusions Following resection of HCC in the setting of no cirrhosis, more than one-half of patients were alive after 5 years. However, even among patients with no cirrhosis, recurrence was common. Factors associated with RFS and overall survival included tumor characteristics, such as tumor capsule, satellite lesions, and vascular invasion.

Prognostic Significance of Sarcomatous Change in Patients with Hepatocellular Carcinoma After Surgical Resection

“…[18][19][20][21] Consistent with the previous studies, our univariate analysis also demonstrated that predictors influencing DFS of HCC with SC were largely tumor-related (Table 3). However, in the multivariate analysis, only macrovascular invasion, lymph node metastasis, satellite nodules, and R1/R2 resection were independent risk factors influencing DFS (Table 3).…”

Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative intent surgical resection.

“…In general, similar to previous studies, patients had surveillance imaging every 3-4 months for the first 1-3 years and every 6 months from 3 to 5 years. [22][23][24] Information regarding the location and number of lesions, as well as the disease-free interval from the date of initial operation to the development of recurrent disease was recorded. For the cohort of patients who developed repeat recurrences, data on the pattern and time interval between subsequent recurrences also were noted.…”

Thymosin α1 therapy subsequent to radical hepatectomy in patients with hepatitis B virus-associated hepatocellular carcinoma: A retrospective controlled study

“…Surgical resection remains the most effective curative treatment for HCC (2), but the high incidence of tumor recurrence makes long-term survival following resection unsatisfactory (3,4). Reducing postoperative recurrence is one of the most significant challenges to improving the prognosis of patients with HCC (5).…”