Recurrent hepatocellular carcinoma after hepatic resection: prognostic factors and long-term outcome

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Abstract

Aim. The prognosis of patients with recurrent hepatocellular carcinoma (HCC) after hepatic resection varies widely. This study analyzed long-term survival and prognostic factors of patients with recurrent HCC after hepatectomy.

Methods. From July 1991 to December 2000, 623 patients underwent hepatic resection for HCC. Of those, 347 (56.5%) patients had tumour recurrence, and 286 patients with follow-up time more than 24 months after recurrence were enrolled. Twenty-seven clinicopathologic factors underwent both univariate and multivariate analysis.

Results. Of these 286 patients, survival times after tumour recurrence were mean 672±619 days; median 468 days; and, range 10–3753 days. The overall 1-, 3-, 5-, and 10-year post-recurrence survival rates were 61.5, 33.4, 18.2, and 9.0%, respectively. Seventy (24.5%) patients were alive at the time of study, and 10 of the 34 patients who underwent re-resection were disease-free. By Cox regression analysis, multiple initial tumours (relative risk (RR) 1.428), recurrent multiple (RR 1.372), extrahepatic recurrence (RR 2.434), recurrent tumour size >2 cm (RR 1.926), post-hepatectomy period until recurrence <1 year (RR 1.769), and non-resectional treatment of recurrent tumours (RR 3.527) were independent prognostic factors for post-recurrent survival rates.

Conclusions. In patients with recurrent HCC after hepatectomy, both initial and recurrent tumour factors influenced their prognosis. Early detection of recurrent tumours is important. Re-resection correlated with better post-recurrent survival rates.

Introduction

Hepatocellular carcinoma (HCC) is a common malignancy worldwide1 and has been difficult to treat successfully. Although surgical resection offers patients with HCC a chance for cure, the post-resectional tumour recurrence rate is high with a cumulative 5-year tumour recurrence rates ranging from 40 to 70%.2., 3.

In HCC patients, many studies have described the prognostic factors related to post-hepatectomy recurrence or survival, but little has been documented on the characteristics and long-term prognosis of patients with recurrent HCC. In prolonging survival after resection of HCC, effective treatment of patients with recurrence is critical. Several investigators have demonstrated that aggressive management of patients with intrahepatic and/or extrahepatic recurrences of HCC, including repeat hepatic resection4., 5. and resection of isolated extrahepatic recurrence,6 offers patients a chance of long-term survival.

Our study aimed to determine the prognosis of patients with recurrent HCC after a hepatic resection and identify the factors related to survival after tumour recurrence.

Section snippets

Patients and methods

Between July 1991 and December 2000, 623 patients with HCC underwent curative hepatic resection at the Department of Surgery, Taipei Veterans General Hospital, Taiwan. A curative resection was defined as an operation in which all the tumours were macroscopically resected during surgery. Thirty-two patients had a microscopic positive surgical margin on subsequent histologic examination. Details of pre-operative investigations, operative techniques, and perioperative management have been reported

Prognosis after tumour recurrence

Of the 286 patients, the disease-free survival periods after hepatic resection were mean 15.4±17.5 months; median 9.0 months; and range 1–97.4 months. The overall survival periods after hepatic resection were mean 39.7±30.6 months; median 31.0 months; and range 1.7–137.4 months. Survival times after tumour recurrence were mean 24.3±22.4 months; median 17.8 months; and range 10 days–135 months. The overall 1-, 3-, 5-, and 10-year survival rates from the time of recurrence were 61.5, 33.4, 18.2,

Discussion

This study demonstrates that prognosis of patients with recurrent HCC varied widely with 60.5% patients died within 2 years after tumour recurrence while 8.0% of patients survived more than 5 years. Independent adverse factors of survival after HCC recurrence included multiple initial tumours, period until recurrence <1 year, presence of extrahepatic recurrence, recurrent tumour size >2 cm, multiple recurrent tumours, and non-resectional treatment for recurrent tumour(s). These findings

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