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01-08-2007 | Hepatic and Pancreatic Tumors

Analysis of Prognostic Factors Affecting Survival After Initial Recurrence and Treatment Efficacy for Recurrence in Patients Undergoing Potentially Curative Hepatectomy for Hepatocellular Carcinoma

Authors: Kazuaki Shimada, MD, Yoshihiro Sakamoto, MD, Minoru Esaki, MD, Tomoo Kosuge, MD, Chigusa Morizane, MD, Masafumi Ikeda, MD, Hideki Ueno, MD, Takuji Okusaka, MD, Yasuaki Arai, MD, Kenichi Takayasu, MD

Published in: Annals of Surgical Oncology | Issue 8/2007

Abstract

Background

Survival analysis in patients with initial recurrence after curative hepatectomy for hepatocellular carcinoma (HCC) has not been well evaluated. In addition, selections of the most effective treatments for patients with recurrent HCC still remain controversial.

Methods

Three hundred and nineteen patients who underwent potentially curative hepatectomies were followed for initial recurrence, and factors predictive of recurrence were determined. The factors affecting survival including pattern of recurrence and treatment modalities from the time of initial recurrence in 211 patients were retrospectively analyzed.

Results

The overall 5-year disease-free survival rate of 319 patients was 31.1%. The 5-year survival rate of 211 patients from the time of initial recurrence was 31.9%. In a multivariate analysis, a low indocyanine green retention rate, lack of liver cirrhosis, a long interval before recurrence, the absence of portal vein invasion, and intrahepatic recurrence (≤3 nodules) were shown to be significantly favorable prognostic factors after the initial recurrence. The 5-year survival rate of patients with intrahepatic recurrence (≤3 nodules) was 42.3%, and no survival differences were observed among different treatment modalities.

Conclusion

When the initial recurrence occurred after a longer interval, and/or with three or fewer intrahepatic recurrent nodules, a favorable prognosis could be expected in those patients with better liver function and no portal vein invasion at the time of the primary hepatectomy. It is important to conduct a randomized controlled trial to clarify a method for selecting optimal treatment in patients with a smaller number of initial intrahepatic recurrences.

Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 2000; 191:38–46PubMedCrossRef

Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 2002; 236:397–406PubMedCrossRef

Imamura H, Seyama Y, Kokudo N, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 2003; 138:1198–206PubMedCrossRef

Takenaka K, Adachi E, Nishizaki T, et al. Possible multicentric occurrence of hepatocellular carcinoma: a clinicopathological study. Hepatology 1994; 19:889–94PubMedCrossRef

Funaki NO, Tanaka J, Seto S, et al. Hematogenous spreading of hepatocellular carcinoma cells: possible participation in recurrence in the liver. Hepatology 1997; 25:564–8PubMedCrossRef

Okuda K. Early detection of hepatocellular carcinoma. Hepatology 1986; 6:729–38PubMedCrossRef

Takayasu K, Furukawa H, Wakao F, et al. CT diagnosis of early hepatocellular carcinoma: sensitivity, findings, and CT-pathologic correlation. Am J Roentgenol 1995; 164:885–90

Takayama T, Makuuchi M, Hirohashi S, et al. Early hepatocellular carcinoma as an entity with a high rate of surgical cure. Hepatology 1998; 28:1241–6PubMedCrossRef

Nakajima Y, Ohmura T, Kimura J, et al. Role of surgical treatment for recurrent hepatocellular carcinoma after hepatic resection. World J Surg 1993; 17:792–5PubMedCrossRef

10.

Suenaga M, Sugiura H, Kokuba Y, et al. Repeated hepatic resection for recurrent hepatocellular carcinoma in eighteen cases. Surgery 1994; 115:452–7PubMed

11.

Hu RH, Lee PH, Yu SC, et al. Surgical resection for recurrent hepatocellular carcinoma: prognosis and analysis of risk factors. Surgery 1996; 120:23–29PubMedCrossRef

12.

Shimada M, Takenaka K, Taguchi K, et al. Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg 1998; 227:80–5PubMedCrossRef

13.

Poon RTP, Fan ST, Lo CM, et al. Intrahepatic recurrence after curative recurrence of hepatocellular carcinoma: Long-term results of treatment and prognostic factors. Ann Surg 1999; 229:216–22PubMedCrossRef

14.

Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 2003; 238:703–10PubMedCrossRef

15.

Yamamoto J, Okada S, Shimada K, et al. Treatment strategy for small hepatocellular carcinoma: Comparison of long-term results after percutaneous ethanol injection therapy and surgical resection. Hepatology 2001; 34:707–13PubMedCrossRef

16.

Taura K, Ikai I, Hatano E, Fujii H, Uyama N, Shimaharu Y. Implication of frequent local ablation therapy for intrahepatic recurrence in prolonged survival of patients with hepatocellular carcinoma undergoing hepatic resection An analysis of 610 patients over 16 years old. Ann Surg 2006; 244:265–73PubMedCrossRef

17.

Lee PH, Lin WJ, Tsang YM, et al. Clinical management of recurrent hepatocellular carcinoma. Ann Surg 1995; 222:670–6PubMedCrossRef

18.

Takayasu K, Arii S, Ikai I, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 2006; 131:461–9PubMedCrossRef

19.

Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinoma in patients with cirrhosis. N Engl J Med 1996; 334:693–9PubMedCrossRef

20.

Todo S, Furukawa H. Living donor liver transplantation for adult patients with hepatocellular carcinoma Experience in Japan. Ann Surg 2004; 240:451–61PubMedCrossRef

21.

Arii S, Tanaka J, Yamazoe Y, et al. Predictive factors for intrahepatic recurrence of hepatocellular carcinoma after partial hepatectomy. Cancer 1991; 69:913–9CrossRef

22.

Nagasue N, Uchida M, Makino Y, et al. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology 1993; 105:488–94PubMed

23.

Okada S, Shimada K, Yamamoto J, et al. Predictive factors for postoperative recurrence of hepatocellular carcinoma. Gastroenterology 1994; 106:1618–24PubMed

24.

Poon RTP, Ng IO, Fan ST, et al. Clinicopathologic features of long-term survivors and disease-free survivors after resection of hepatocellular carcinoma: A study of a prospective cohort. J Clin Oncol 2001; 19:3037–44PubMed

25.

Portolani N, Coniglio A, Giovanelli M, et al. Early and late recurrence after resection for hepatocellular carcinoma Prognosis and therapeutic implications. Ann Surg 2006 243:229–35PubMedCrossRef

26.

Shimada M, Takenaka K, Gion T, et al. Prognosis of recurrent hepatocellular carcinoma: A 10-year surgical experience in Japan. Gastroenterology 1996; 111:720–6PubMedCrossRef

27.

Miyagawa M, Makuuchi M, Kawasaki S, et al. Criteria for safe hepatic resection. Am J Surg 1995; 169:589–94PubMedCrossRef

28.

Liver Cancer Study Group of Japan. General Rules for the Clinical and Pathological Study of Primary Liver Cancer, 2nd ed. Tokyo: Kanehara, 2003

29.

Yamanaka N, Tanaka T, Tanaka W, et al. Correlation of hepatitis virus serologic status with clinicopathologic features in patients undergoing hepatectomy for hepatocellular carcinoma. Cancer 1997; 79:1509–15PubMedCrossRef

30.

Shiratori Y, Shiina S, Teratani T, et al. Interferon therapy after tumor ablation improves prognosis in patients with hepatocellular carcinoma associated with hepatitis C virus. Ann Intern Med 2003; 138:299–306PubMed

31.

Park JH, Koh KC, Choi MS, et al. Analysis of risk factors associated with early multinodular recurrences after hepatic resection for hepatocellular carcinoma. Am J Surg 2006; 192:29–33PubMedCrossRef

32.

Sakon M, Nagano H, Dono K, et al. Combined intraarterial 5-fluorouracil and subcutaneous interferon-alpha therapy for advanced hepatocellular carcinoma with tumor thrombi in the major portal branches. Cancer 2002; 94:435–42PubMedCrossRef

33.

Ando E, Tanaka M, Yamashita F. Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: analysis of 48 cases. Cancer 2002; 95:588–95PubMedCrossRef

34.

Ryu M, Shimamura Y, Kinoshita T, et al. Therapeutic results of resection, transcatheter arterial embolization and percutaneous transhepatic ethanol injection in 3225 patients with hepatocellular carcinoma: a prospective multicenter study. Jpn J Clin Oncol 1997; 27:251–7PubMedCrossRef

35.

Matsui O, Kadoya N, Yoshikawa J, et al. Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization. Radiology 1993; 188:79–83PubMed

36.

Takayasu K, Muramatsu Y, Maeda T, et al. Targeted transarterial oily chemoembolization for small foci of hepatocellular carcinoma using a unified helical CT and angiography system: analysis of factors affecting local recurrence and survival rates. Am J Roentgenol 2001; 176:681–8

37.

Lau WY, Leung TWT, Yu SCH, Ho SKW. Percutaneous local ablate therapy for hepatocellular carcinoma A review and look into the future. Ann Surg 2003; 2:171–9CrossRef

38.

Lau WY, Leung TW, Ho SK, et al. Adjuvant intra-arterial iodine-131-labelled lipiodol for resectable hepatocellular carcinoma: a prospective randomized trial. Lancet 1999; 353:797–801PubMedCrossRef

Title: Analysis of Prognostic Factors Affecting Survival After Initial Recurrence and Treatment Efficacy for Recurrence in Patients Undergoing Potentially Curative Hepatectomy for Hepatocellular Carcinoma
Authors: Kazuaki Shimada, MD
Yoshihiro Sakamoto, MD
Minoru Esaki, MD
Tomoo Kosuge, MD
Chigusa Morizane, MD
Masafumi Ikeda, MD
Hideki Ueno, MD
Takuji Okusaka, MD
Yasuaki Arai, MD
Kenichi Takayasu, MD
Publication date: 01-08-2007
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 8/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-007-9415-7

Keynote webinar | Spotlight on medication adherence

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Analysis of Prognostic Factors Affecting Survival After Initial Recurrence and Treatment Efficacy for Recurrence in Patients Undergoing Potentially Curative Hepatectomy for Hepatocellular Carcinoma

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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