Liver resection for large and huge hepatocellular carcinoma: Predictors of failure, recurrence patterns, and prognoses. Issue 2 (11th April 2022)

• Record Type: Journal Article
• Authors: Xiang, Cailing; Xiao, Yating; Ma, Zhongzhi; Peng, Yuchong; Li, Xun; Mao, Xianhai; Li, Lequn
• Is Part Of: Asia-Pacific journal of clinical oncology. Volume 19:Issue 2(2023)
• Page Start: e60
• Page End: e70
• Publication Date: 2022-04-11
• Subjects: large and huge hepatocellular carcinoma -- liver resection -- prognosis -- risk factor; Oncology -- Pacific Area -- Periodicals; Cancer -- Treatment -- Pacific Area -- Periodicals; Cancer -- Pacific Area -- Periodicals; Cancer -- Treatment -- Periodicals; 616.9940095
• DOI: 10.1111/ajco.13777
• Languages: English
• ISSNs: 1743-7555

Abstract

Abstract: Background: Characteristic symptoms and signs are often absent in patients with hepatocellular carcinoma (HCC). As a result, many patients are not diagnosed until their tumors have grown to large (> 5cm) or huge sizes (> 10cm). Liver resection has traditionally been reserved for patients with small HCC, but more recently it is being used for patients with large and huge tumors. The aim of this study was to determine risk predictors of recurrence, patterns of recurrence, and survival rates for large and huge HCC patients who underwent curative liver resection. Materials and methods: We retrospectively identified a subgroup of patients who underwent liver resection for HCC with diameters 5 cm or larger. Overall survival (OS) and recurrence‐free survival (RFS) rates were calculated using the Kaplan–Meier method. Univariate and multivariate Cox regression analyses were performed to investigate potential risk factors for recurrence and death. Results: Among 897 patients, the median follow‐up was 48 (range, 5–140) months. The 1‐, 3‐, and 5‐year RFS rates were 51.6%, 36.1%, and 30.1%, respectively, and OS rates were 80.2%, 55.4%, and 47.7%, respectively. Significant independent predictors of recurrence were preoperative satellite nodule (HR = 2.25; 95% CI, 1.17–4.31; p = .02), preoperative AFP levels above 400 ng/ml (HR = 1.23; 95% CI, 1.04–1.45; p = .01), resection margins of 1 cm or less (HR = 1.21; 95% CI, 1.00–1.46; p = .047), cirrhosis (HR = 2.64; 95% CI, 2.13–3.28; p < .001), and microvascular invasion (HR = 1.71; 95% CI, 1.45–2.20; p < .001). All of these except narrow resection margin were also independent risk factors of OS. Conclusions: Hepatic resection for patients with large and huge HCC without hepatic vascular invasion, extrahepatic metastases, or severe chronic liver disease results in acceptable long‐term outcomes. Abstract : In this paper, 897 large and huge HCC patients were included to determine risk predictors of recurrence after they received curative resection. Our results showed that significant independent predictors of recurrence were preoperative satellite nodules and AFP levels above 400 ng/mL, resection margins of 1 cm or less, cirrhosis, and microvascular invasion.