Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey

Abstract

BACKGROUND Advances in the diagnosis and surgical treatment of hepatocellular carcinoma (HCC) have improved the prognosis for patients with HCC who undergo liver resection. The objective of this study was to evaluate prognostic predictors for patients with HCC who underwent liver resection in a Japanese nationwide data base. METHODS In this study, the authors analyzed 12,118 patients with HCC in a Japanese nationwide data base who underwent liver resection between 1990 and 1999 and compared them with a previous analysis of patients between 1982 and 1989. All patients were evaluated for prognostic factors. RESULTS During the last decade, the increases in patients who were without hepatitis B virus surface antigen, who had small tumors, and who had portal vein invasion were noted. The 5‐year overall survival rates for patients with HCC improved to 50.5%, compared with < 40% in the previous analysis. A multivariate analysis using a stratified Cox proportional hazards model according to associated liver disease indicated that age, degree of liver damage, α‐fetoprotein level, maximal tumor dimension, number of tumors, intrahepatic extent of tumor, extrahepatic metastasis, portal vein invasion, hepatic vein invasion, surgical curability, and free surgical margins were independent prognostic predictors for patients with HCC. Operative mortality decreased from 2.3% in 1990–1991 to 0.6% in 1998–1999. CONCLUSIONS Outcomes and operative mortality rates in patients with HCC improved during the last decade. Age, degree of liver damage, α‐fetoprotein level, maximal tumor dimension, number of tumors, intrahepatic extent of tumor, extrahepatic metastasis, portal vein invasion, hepatic vein invasion, surgical curability, and free surgical margins were prognostic factors for patients with HCC who underwent liver resection. Cancer 2004. © 2004 American Cancer Society.

Current management of hepatocellular carcinoma: An Eastern perspective

“…Five-year survival rates are > 50% after the resection of solitary tumors, whereas rates of 20%-30% have been reported for 3 or more nodules [28][29][30] . With respect to tumor size, 5-year survival rates for patients with HCCs < 2 cm, 2-5 cm, and > 5 cm are 66%, 52%, and 37%, respectively [28][29][30] . However, in selected cases with proper hepatic function, large single HCCs can be surgically removed with favorable long-term survival outcomes [29] .…”

“…Although the BCLC algorithm mandates Child-Pugh A liver function without portal hypertension for hepatic resection, selective resection has been attempted in HCC patients exhibiting upper Child-Pugh B liver function or mild portal hypertension in Asian countries, with reference to the ICG15 value [6,26] . Prognosis after hepatic resection is determined by number and size of tumor, vascular invasion, and level of alpha-fetoprotein [28][29][30] . Five-year survival rates are > 50% after the resection of solitary tumors, whereas rates of 20%-30% have been reported for 3 or more nodules [28][29][30] .…”

“…Prognosis after hepatic resection is determined by number and size of tumor, vascular invasion, and level of alpha-fetoprotein [28][29][30] . Five-year survival rates are > 50% after the resection of solitary tumors, whereas rates of 20%-30% have been reported for 3 or more nodules [28][29][30] . With respect to tumor size, 5-year survival rates for patients with HCCs < 2 cm, 2-5 cm, and > 5 cm are 66%, 52%, and 37%, respectively [28][29][30] .…”

What is the best staging system for hepatocellular carcinoma in the setting of liver transplantation?

“…Numerous publications have cited a strong correlation between recurrent disease and high AFP levels, and some have suggested an AFP level > 400 ng/mL as a cutoff. [47][48][49][50][51][52][53] There is still no agreement about or strong evidence for using a specific AFP level as a cutoff in clinical practice.…”

Toward a rational management of very early hepatocellular carcinoma

“…7 Lee el al. 8 reported a 3-year survival of 82.5% for tumors 2 cm and 67.7% for tumors between 2 and 3 cm.…”