Skip to main content
Top
Published in: World Journal of Surgery 2/2007

01-02-2007

Clinicopathologic Features of Hepatocellular Carcinoma Patients with Compensated Cirrhosis Surviving More than 10 Years after Curative Hepatectomy

Authors: Saburo Fukuda, MD, Toshiyuki Itamoto, MD, Hironobu Amano, MD, Toshihiko Kohashi, MD, Hideki Ohdan, MD, Hirotaka Tashiro, MD, Toshimasa Asahara, MD

Published in: World Journal of Surgery | Issue 2/2007

Login to get access

Abstract

Background

The aim of this study was to clarify the clinicopathologic features of hepatocellular carcinoma (HCC) patients with compensated cirrhosis surviving more than 10 years after initial hepatectomy.

Study Design

Among 250 patients who underwent hepatectomy for HCC between 1987 and 1994 at our institute, 145 patients who had Child-Pugh class A liver function and who underwent curative resection were included in this study. Clinicopathologic factors in 10-year survivors and patients who died within 10 years (nonsurvivors) were compared, and the prognostic factors affecting survival were identified.

Results

There were 29 patients who survived for more than 10 years after initial hepatectomy, and 9 of those patients survived without cancer recurrence. The 3-, 5-, and 10-year survival rates were 76.2%, 53.0%, and 26.9% respectively. The corresponding disease-free survival rates were 43.1%, 25.7%, and 9.9% respectively. In multivariate analysis, liver fibrosis grade F0–2, female gender, ICG-R15 value of less than 15%, and absence of microscopic vascular invasion were favorable independent factors associated with 10-year survival. Disease-free interval after initial hepatectomy in 10-year survivors with recurrence was significantly longer than that in nonsurvivors with recurrence, 5.1 and 1.9 years respectively (P = 0.0004). The number of intrahepatic recurrent nodules in 10-year survivors tended to be fewer than that in nonsurvivors.

Conclusions

Based on the results of our study, liver fibrosis grade F0–2, female gender, ICG-R15 value of less than 15% and absence of microscopic vascular invasion at initial hepatectomy might be biologically favorable conditions for long-term survival. Close follow-up as well as multimodal treatment could contribute to prolongation of survival in such patients, even if HCC recurrence develops.
Literature
1.
go back to reference Itamoto T, Katayama K, Nakahara H, et al. Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease. Br J Surg 2003;90:23–28PubMedCrossRef Itamoto T, Katayama K, Nakahara H, et al. Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease. Br J Surg 2003;90:23–28PubMedCrossRef
2.
go back to reference Itamoto T, Nakahara H, Tashiro H, et al. Indications of partial hepatectomy for transplantable hepatocellular carcinoma with compensated cirrhosis. Am J Surg 2005;189:167–172PubMedCrossRef Itamoto T, Nakahara H, Tashiro H, et al. Indications of partial hepatectomy for transplantable hepatocellular carcinoma with compensated cirrhosis. Am J Surg 2005;189:167–172PubMedCrossRef
3.
go back to reference Nakahara H, Itamoto T, Katayama K, et al. Indication of hepatectomy for cirrhotic patients with hepatocellular carcinoma classified as Child-Pugh class B. World J Surg 2005;29:734–738PubMedCrossRef Nakahara H, Itamoto T, Katayama K, et al. Indication of hepatectomy for cirrhotic patients with hepatocellular carcinoma classified as Child-Pugh class B. World J Surg 2005;29:734–738PubMedCrossRef
4.
go back to reference Shirabe K, Shimada M, Kajiyama K, et al. Clinicopathologic features of patients with hepatocellular carcinoma surviving >10 years after hepatic resection. Cancer 1998;83:2312–3216PubMedCrossRef Shirabe K, Shimada M, Kajiyama K, et al. Clinicopathologic features of patients with hepatocellular carcinoma surviving >10 years after hepatic resection. Cancer 1998;83:2312–3216PubMedCrossRef
5.
go back to reference Shimada K, Sano T, Sakamoto Y, et al. A long-term follow-up and management study of hepatocellular carcinoma patients surviving for 10 years or longer after curative hepatectomy. Cancer 2005;104:1939–1947PubMedCrossRef Shimada K, Sano T, Sakamoto Y, et al. A long-term follow-up and management study of hepatocellular carcinoma patients surviving for 10 years or longer after curative hepatectomy. Cancer 2005;104:1939–1947PubMedCrossRef
6.
go back to reference Ichida F, Tsuji T, Omata M, et al. New Inuyama classification: new criteria for histological assessment of chronic hepatitis. Int Hepatol Commun 1996;6:112–119CrossRef Ichida F, Tsuji T, Omata M, et al. New Inuyama classification: new criteria for histological assessment of chronic hepatitis. Int Hepatol Commun 1996;6:112–119CrossRef
7.
go back to reference Fukuda S, Itamoto T, Nakahara H, et al. Clinicopathologic features and prognostic factors of resected solitary small-sized hepatocellular carcinoma. Hepatogastroenterology 2005;52:1163–1167PubMed Fukuda S, Itamoto T, Nakahara H, et al. Clinicopathologic features and prognostic factors of resected solitary small-sized hepatocellular carcinoma. Hepatogastroenterology 2005;52:1163–1167PubMed
8.
go back to reference Yamamoto J, Kosuge T, Takayama T, et al. Recurrence of hepatocellular carcinoma after surgery. Br J Surg 1996;83:1219–1222PubMedCrossRef Yamamoto J, Kosuge T, Takayama T, et al. Recurrence of hepatocellular carcinoma after surgery. Br J Surg 1996;83:1219–1222PubMedCrossRef
9.
go back to reference Nagao T, Inoue S, Yoshimi F, et al. Postoperative recurrence of hepatocellular carcinoma. Ann Surg 1990;211:28–33PubMedCrossRef Nagao T, Inoue S, Yoshimi F, et al. Postoperative recurrence of hepatocellular carcinoma. Ann Surg 1990;211:28–33PubMedCrossRef
10.
go back to reference Shimada M, Takenaka K, Taguchi K, et al. Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg 1998;227:80–95PubMedCrossRef Shimada M, Takenaka K, Taguchi K, et al. Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg 1998;227:80–95PubMedCrossRef
11.
go back to reference Nagasue N, Yu L, Yukaya H, et al. Androgen and oestrogen receptors in hepatocellular carcinoma and surrounding liver parenchyma: impact on intrahepatic recurrence after hepatic resection. Br J Surg 1995;82:542–547PubMed Nagasue N, Yu L, Yukaya H, et al. Androgen and oestrogen receptors in hepatocellular carcinoma and surrounding liver parenchyma: impact on intrahepatic recurrence after hepatic resection. Br J Surg 1995;82:542–547PubMed
12.
13.
go back to reference Imamura H, Sano K, Sugawara Y, et al. Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepatobiliary Pancreat Surg 2005;12:16–22PubMedCrossRef Imamura H, Sano K, Sugawara Y, et al. Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepatobiliary Pancreat Surg 2005;12:16–22PubMedCrossRef
14.
go back to reference Bilimoria MM, Lauwers GY, Doherty DA, et al. Underlying liver disease, not tumor factors, predicts long-term survival after resection of hepatocellular carcinoma. Arch Surg 2001;136:528–535PubMedCrossRef Bilimoria MM, Lauwers GY, Doherty DA, et al. Underlying liver disease, not tumor factors, predicts long-term survival after resection of hepatocellular carcinoma. Arch Surg 2001;136:528–535PubMedCrossRef
15.
go back to reference Wayne JD, Lauwers GY, Ikai I, et al. Preoperative predictors of survival after resection of small hepatocellular carcinomas. Ann Surg 2002;235:722–730PubMedCrossRef Wayne JD, Lauwers GY, Ikai I, et al. Preoperative predictors of survival after resection of small hepatocellular carcinomas. Ann Surg 2002;235:722–730PubMedCrossRef
16.
go back to reference Ko S, Kanehiro H, Hisanaga M, et al. Liver fibrosis increases the risk of intrahepatic recurrence after hepatectomy for hepatocellular carcinoma. Br J Surg 2002;89:57–62PubMedCrossRef Ko S, Kanehiro H, Hisanaga M, et al. Liver fibrosis increases the risk of intrahepatic recurrence after hepatectomy for hepatocellular carcinoma. Br J Surg 2002;89:57–62PubMedCrossRef
17.
go back to reference Yoshida H, Shiratori Y, Moriyama M, et al. Interferon therapy reduces the risk for hepatocellular carcinoma: national surveillance program of cirrhotic and noncirrhotic patients with chronic hepatitis C in Japan. IHIT Study Group. Inhibition of Hepatocarcinogenesis by Interferon Therapy. Ann Intern Med 1999;131:174–181PubMed Yoshida H, Shiratori Y, Moriyama M, et al. Interferon therapy reduces the risk for hepatocellular carcinoma: national surveillance program of cirrhotic and noncirrhotic patients with chronic hepatitis C in Japan. IHIT Study Group. Inhibition of Hepatocarcinogenesis by Interferon Therapy. Ann Intern Med 1999;131:174–181PubMed
18.
go back to reference Takenaka K, Yamamoto K, Taketomi A, et al. A comparison of the surgical results in patients with hepatitis B versus hepatitis C-related hepatocellular carcinoma. Hepatology 1995;22:20–24PubMedCrossRef Takenaka K, Yamamoto K, Taketomi A, et al. A comparison of the surgical results in patients with hepatitis B versus hepatitis C-related hepatocellular carcinoma. Hepatology 1995;22:20–24PubMedCrossRef
19.
go back to reference Miyagawa S, Kawasaki S, Makuuchi M. Comparison of the characteristics of hepatocellular carcinoma between hepatitis B, C viral infection: tumor multicentricity in cirrhotic liver with hepatitis C. Hepatology 1996;24:307–310PubMedCrossRef Miyagawa S, Kawasaki S, Makuuchi M. Comparison of the characteristics of hepatocellular carcinoma between hepatitis B, C viral infection: tumor multicentricity in cirrhotic liver with hepatitis C. Hepatology 1996;24:307–310PubMedCrossRef
20.
go back to reference Ikeda K, Arase Y, Saitoh S, et al. Interferon beta prevents recurrence of hepatocellular carcinoma after complete resection or ablation of the primary tumor—a prospective randomized study of hepatitis C virus-related liver cancer. Hepatology 2000;32:228–232PubMedCrossRef Ikeda K, Arase Y, Saitoh S, et al. Interferon beta prevents recurrence of hepatocellular carcinoma after complete resection or ablation of the primary tumor—a prospective randomized study of hepatitis C virus-related liver cancer. Hepatology 2000;32:228–232PubMedCrossRef
21.
go back to reference Kubo S, Nishiguchi S, Hirohashi K, et al. Randomized clinical trial of long-term outcome after resection of hepatitis C virus-related hepatocellular carcinoma by postoperative interferon therapy. Br J Surg 2002;89:418–422PubMedCrossRef Kubo S, Nishiguchi S, Hirohashi K, et al. Randomized clinical trial of long-term outcome after resection of hepatitis C virus-related hepatocellular carcinoma by postoperative interferon therapy. Br J Surg 2002;89:418–422PubMedCrossRef
22.
go back to reference Nagasue N, Ono T, Yamanoi A, et al. Prognostic factors and survival after hepatic resection for hepatocellular carcinoma without cirrhosis. Br J Surg 2001;88:515–522PubMedCrossRef Nagasue N, Ono T, Yamanoi A, et al. Prognostic factors and survival after hepatic resection for hepatocellular carcinoma without cirrhosis. Br J Surg 2001;88:515–522PubMedCrossRef
23.
go back to reference Nagashima I, Hamada C, Naruse K, et al. Surgical resection for small hepatocellular carcinoma. Surgery 1996;119:40–45PubMedCrossRef Nagashima I, Hamada C, Naruse K, et al. Surgical resection for small hepatocellular carcinoma. Surgery 1996;119:40–45PubMedCrossRef
24.
go back to reference Lise M, Bacchetti S, Da Pian P, et al. Prognostic factors affecting long term outcome after liver resection for hepatocellular carcinoma: results in a series of 100 Italian patients. Cancer 1998;82:1028–1036PubMedCrossRef Lise M, Bacchetti S, Da Pian P, et al. Prognostic factors affecting long term outcome after liver resection for hepatocellular carcinoma: results in a series of 100 Italian patients. Cancer 1998;82:1028–1036PubMedCrossRef
25.
go back to reference Poon RT, Fan ST, Ng IO, et al. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer 2000;89:500–507PubMedCrossRef Poon RT, Fan ST, Ng IO, et al. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer 2000;89:500–507PubMedCrossRef
26.
go back to reference Minagawa M, Makuuchi M, Takayama T, et al. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 2003;238:703–710PubMedCrossRef Minagawa M, Makuuchi M, Takayama T, et al. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 2003;238:703–710PubMedCrossRef
27.
go back to reference Poon RT, Fan ST, Lo CM, et al. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 1999;229:216–222PubMedCrossRef Poon RT, Fan ST, Lo CM, et al. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 1999;229:216–222PubMedCrossRef
28.
go back to reference Shimozawa N, Hanazaki K. Longterm prognosis after hepatic resection for small hepatocellular carcinoma. J Am Coll Surg 2004;198:356–365PubMedCrossRef Shimozawa N, Hanazaki K. Longterm prognosis after hepatic resection for small hepatocellular carcinoma. J Am Coll Surg 2004;198:356–365PubMedCrossRef
29.
go back to reference Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334:693–699PubMedCrossRef Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334:693–699PubMedCrossRef
30.
go back to reference Llovet JM, Bruix J, Fuster J, et al. Liver transplantation for small hepatocellular carcinoma: the tumor-node-metastasis classification does not have prognostic power. Hepatology 1998;27:1572–1577PubMedCrossRef Llovet JM, Bruix J, Fuster J, et al. Liver transplantation for small hepatocellular carcinoma: the tumor-node-metastasis classification does not have prognostic power. Hepatology 1998;27:1572–1577PubMedCrossRef
31.
go back to reference Bismuth H, Majno PE, Adam R. Liver transplantation for hepatocellular carcinoma. Semin Liver Dis 1999;19:311–322PubMedCrossRef Bismuth H, Majno PE, Adam R. Liver transplantation for hepatocellular carcinoma. Semin Liver Dis 1999;19:311–322PubMedCrossRef
32.
go back to reference Bigourdan JM, Jaeck D, Meyer N, et al. Small hepatocellular carcinoma in Child A cirrhotic patients: hepatic resection versus transplantation. Liver Transpl 2003;9:513–520PubMedCrossRef Bigourdan JM, Jaeck D, Meyer N, et al. Small hepatocellular carcinoma in Child A cirrhotic patients: hepatic resection versus transplantation. Liver Transpl 2003;9:513–520PubMedCrossRef
Metadata
Title
Clinicopathologic Features of Hepatocellular Carcinoma Patients with Compensated Cirrhosis Surviving More than 10 Years after Curative Hepatectomy
Authors
Saburo Fukuda, MD
Toshiyuki Itamoto, MD
Hironobu Amano, MD
Toshihiko Kohashi, MD
Hideki Ohdan, MD
Hirotaka Tashiro, MD
Toshimasa Asahara, MD
Publication date
01-02-2007
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 2/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-006-0513-7

Other articles of this Issue 2/2007

World Journal of Surgery 2/2007 Go to the issue

Erratum

ERRATUM