Predictors and patterns of recurrence after resection of hepatocellular carcinoma Journal Article
| Authors: | Cha, C.; Fong, Y.; Jarnagin, W. R.; Blumgart, L. H.; DeMatteo, R. P. |
| Article Title: | Predictors and patterns of recurrence after resection of hepatocellular carcinoma |
| Abstract: | BACKGROUND: The majority of patients with hepatocellular carcinoma (HCC) who undergo complete tumor resection subsequently develop tumor recurrence. The objectives of this study were to determine the risk factors for recurrence of HCC after hepatectomy and to examine the outcomes once tumor recurrence occurs. STUDY DESIGN: From February 1990 to May 2001 a total of 164 patients underwent liver resection for HCC at our institution and were prospectively followed. Time to recurrence and survival after recurrence were determined by Kaplan-Meier analysis. Patient, tumor, and treatment characteristics were tested for their prognostic significance by univariate and multivariate analysis using the logrank test and the Cox proportional hazards model, respectively. RESULTS: The median patient age was 64 years (range 21 to 87 years) and 106 patients (65%) were male. After a median followup of 26 months, 90 patients (55%) have developed recurrent cancer. Among them, 75 patients (83%) had tumor detectable in the liver, which was the only site of disease in 67 (74%). In all, 15 patients (20%) had extrahepatic disease (7 lung, 4 peritoneum, 2 pancreas, 1 bone, and 1 brain). The median time to recurrence was 24 months (range 1 to 274 months). Predictors of recurrence on univariate analysis were tumor size greater than 5 cm, more than one tumor, cirrhosis, vascular invasion (microscopic or macroscopic), and tumor satellites. On multivariate analysis only tumor size greater than 5 cm (p = 0.04) and vascular invasion (p = 0.01) predicted recurrence. The median survival after recurrence was 11 months (range 0 to 60 months). Of the 90 patients who developed tumor recurrence 49 (67%) were able to undergo additional ablative or surgical therapy (33 embolization, 9 ethanol injection, and 14 re-resection). On multivariate analysis vascular invasion in the original tumor predicted poor survival after recurrence (p = 0.009). CONCLUSIONS: The liver is the predominant site of first recurrence after resection of hepatocellular carcinoma, and once recurrence occurs survival is limited. The current study underscores the need for effective adjuvant therapy for patients with HCC treated with partial hepatectomy. © 2003 by the American College of Surgeons. |
| Keywords: | survival; adult; cancer survival; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; cancer surgery; major clinical study; mortality; cancer localization; cancer recurrence; artificial embolism; cancer risk; liver cell carcinoma; liver cirrhosis; patient selection; carcinoma, hepatocellular; liver neoplasms; united states; cancer adjuvant therapy; cancer staging; follow up; methodology; neoplasm staging; prospective study; prospective studies; neoplasm recurrence, local; proportional hazards models; risk factors; prediction; risk factor; time; time factors; postoperative complication; cancer center; proportional hazards model; statistical analysis; tumor recurrence; liver tumor; cancer size; reoperation; prediction and forecasting; predictive value of tests; cancer care facilities; liver resection; new york city; hepatectomy; multivariate analysis; kaplan meier method; analysis of variance; catheter ablation; actuarial analysis; humans; prognosis; human; male; female; priority journal; article |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 197 |
| Issue: | 5 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2003-11-01 |
| Start Page: | 753 |
| End Page: | 758 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2003.07.003 |
| PUBMED: | 14585409 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 12 September 2014 -- Source: Scopus |
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