Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma Journal Article

Authors: Vauthey, J. N.; Klimstra, D.; Franceschi, D.; Tao, Y.; Fortner, J.; Blumgart, L.; Brennan, M.
Article Title: Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma
Abstract: Background: Experience with hepatocellular carcinoma (HCC) is limited in the West and factors affecting outcome after resection are not clearly defined. Methods: Between 1970 and 1992, 106 patients (including 74 Caucasians, 31 Orientals, and 1 black) underwent hepatic resection for HCC at Memorial Sloan-Kettering Cancer Center. Clinical and histopathologic factors of outcome were analyzed. Results: Cirrhosis was present in 33% and 95% were Child-Pugh A. Operative mortality was 6%, 14% in cirrhotics versus 1% in noncirrhotics (P = 0.013). Orientals had a higher prevalence of cirrhosis (68% versus 19%) (P <0.0001) and smaller tumors (mean 8.7 cm versus 11.0 cm) (P = 0.028) compared to Caucasians. Overall survival was 41% and 32% at 5 and 10 years, respectively. By univariate analysis, survival was greater in association with the following: absence of vascular invasion (69% versus 28%, P = 0.002); absence of symptoms (66% versus 38%, P = 0.014); solitary tumor (53% versus 28%, P = 0.014); negative margins (46% versus 21%, P = 0.022); small tumor (≤5 cm) (75% versus 36%, P = 0.027); and presence of tumor capsule (69% versus 35%, P = 0.047). Ethnic origin, cirrhosis, necrosis and grade did not affect survival. By multivariate analysis, only vascular invasion predicted outcome (P = 0.0025, risk ratio 2.9). Conclusions: One third of patients resected for HCC can be expected to survive long-term. Except for a higher incidence of cirrhosis in Orientals, no major histopathologic or prognostic differences were noted between Orientals and Caucasians undergoing resection. Early cirrhosis (Child-Pugh A) did not adversely affect survival. Vascular invasion predicted long-term outcome. © 1995.
Keywords: survival; adolescent; adult; controlled study; human tissue; treatment outcome; aged; aged, 80 and over; survival rate; retrospective studies; major clinical study; hepatitis b; liver cell carcinoma; liver cirrhosis; carcinoma, hepatocellular; liver neoplasms; conference paper; tumor volume; incidence; risk factors; prediction; postoperative complication; cancer invasion; long term care; blood vessel; liver resection; hepatectomy; tumor growth; ethnic difference; middle age; liver necrosis; human; male; female; priority journal; support, non-u.s. gov't; mongoloid race; caucasoid race
Journal Title: American Journal of Surgery
Volume: 169
Issue: 1
ISSN: 0002-9610
Publisher: Elsevier Inc.  
Date Published: 1995-01-01
Start Page: 28
End Page: 35
Language: English
DOI: 10.1016/s0002-9610(99)80106-8
PUBMED: 7817995
PROVIDER: scopus
Notes: Article -- Export Date: 28 August 2018 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Murray F Brennan
    800 Brennan
  2. Leslie H Blumgart
    346 Blumgart
  3. David S Klimstra
    869 Klimstra
  4. Joseph G Fortner
    19 Fortner
  5. Yue Tao
    17 Tao