Long-term results of hepatic resection for hepatocellular carcinoma originating from the noncirrhotic liver.

HYPOTHESIS In patients with hepatocellular carcinoma who do not have cirrhosis, the clinicopathologic characteristics and long-term postresectional outcomes must be clarified and liver transplantation may also have a role in future treatment strategy. DESIGN Case series. The mean (SD) follow-up time was 52.4 (33.8) months. SETTING A tertiary care medical center. PATIENTS From a prospective database, 445 patients with hepatocellular carcinoma who underwent hepatectomy were classified into 2 groups-those without cirrhosis (n = 223) and those with cirrhosis (n = 222). Clinicopathologic factors and postresectional outcomes were compared between these groups based on the new American Joint Committee on Cancer/Union Internationale Contre le Cancer TNM (sixth edition) staging system and the patient selection criteria for undergoing transplantation. MAIN OUTCOME MEASURES Postresectional disease-free and overall survival rates. RESULTS Compared with patients with cirrhosis, patients without cirrhosis were younger, had a lower rate of viral hepatitis type C infection, and had more advanced TNM stage III disease. Also more of the patients who did not have cirrhosis had undergone major resection. The tumor recurrence rate was significantly lower in the noncirrhotic group than in the cirrhotic group (59.5% vs 69.5%, P =.03). The 5- and 10-year disease-free and overall survival rates of the noncirrhotic group were 36.8% and 25.7%, and 53.0% and 36.9%, respectively. The survival of the members of the noncirrhotic group was better than the survival of the members of the cirrhotic group for patients with early stage (TNM stage I or transplantable) diseases. The 5-year disease-free and overall survival rates in patients without cirrhosis with transplantable diseases were 54.8% and 70.0%, respectively. CONCLUSIONS In early stage diseases, patients without cirrhosis had significantly better survival rates than patients with cirrhosis. For a small hepatocellular carcinoma originating in a noncirrhotic liver, hepatic resection is a reasonable first-line treatment. Liver transplantation can be reserved as salvage treatment for patients with recurrent disease after hepatic resection.

[1]  P. Bachellier,et al.  Small hepatocellular carcinoma in Child A cirrhotic patients: Hepatic resection versus transplantation , 2003, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[2]  A. Gardini,et al.  Liver Resection for Hepatocellular Carcinoma on Cirrhosis: Univariate and Multivariate Analysis of Risk Factors for Intrahepatic Recurrence , 2003, Annals of surgery.

[3]  J. Heiken,et al.  Detection of primary hepatic malignancy in liver transplant candidates: prospective comparison of CT, MR imaging, US, and PET. , 2003, Radiology.

[4]  A. Lauterio,et al.  Liver transplantation for hepatocellular cancer: should the current indication criteria be changed? , 2003, Transplant international : official journal of the European Society for Organ Transplantation.

[5]  R. Wolfe,et al.  Longitudinal assessment of mortality risk among candidates for liver transplantation , 2003, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[6]  D. Hess,et al.  Living related liver transplantation for recurrent hepatocellular carcinoma in a normal liver. , 2002 .

[7]  S. Fan,et al.  Long-Term Survival and Pattern of Recurrence After Resection of Small Hepatocellular Carcinoma in Patients With Preserved Liver Function: Implications for a Strategy of Salvage Transplantation , 2002, Annals of surgery.

[8]  K. Batts,et al.  Prognostic Histologic Indicators of Curatively Resected Hepatocellular Carcinomas: A Multi-institutional Analysis of 425 Patients With Definition of a Histologic Prognostic Index , 2002, The American journal of surgical pathology.

[9]  R. Howard,et al.  Liver transplantation for hepatocellular carcinoma. , 2001, Minerva chirurgica.

[10]  G. Chau,et al.  Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma. , 2000, Surgery.

[11]  J. Figueras,et al.  Resection or transplantation for hepatocellular carcinoma in cirrhotic patients: outcomes based on indicated treatment strategy. , 2000, Journal of the American College of Surgeons.

[12]  S. Iwai,et al.  Retrospective analysis of type of hepatic resection for hepatocellular carcinoma , 2000, The British journal of surgery.

[13]  M. Makuuchi,et al.  No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. , 1999, Archives of surgery.

[14]  H. El‐Serag,et al.  Rising Incidence of Hepatocellular Carcinoma in the United States , 1999, Infection Control & Hospital Epidemiology.

[15]  J. McCall,et al.  Liver transplantation for hepatocellular carcinoma in patients without underlying liver disease: a systematic review. , 1999, Liver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[16]  G. Chau,et al.  Prognostic significance of surgical margin in hepatocellular carcinoma resection: An analysis of 165 Childs' A patients , 1997, Journal of surgical oncology.

[17]  J. Mouiel,et al.  Liver resection or transplantation for hepatocellular carcinoma? Retrospective analysis of 215 patients with cirrhosis. , 1997, Journal of hepatology.

[18]  P. Paliard,et al.  Adult cirrhotic liver explants: precancerous lesions and undetected small hepatocellular carcinomas. , 1996, Gastroenterology.

[19]  M. Schwartz,et al.  Detection of hepatocellular carcinoma in cirrhotic patients: sensitivity of CT and ultrasonography. , 1996, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[20]  ndrea,et al.  Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. , 1996, The New England journal of medicine.

[21]  G. Chau,et al.  Hepatic segmentectomy for curative resection of primary hepatocellular carcinoma. , 1995, Archives of surgery.

[22]  H. Koyama,et al.  Influence of coexisting cirrhosis on long-term prognosis after surgery in patients with hepatocellular carcinoma. , 1992, Surgery.

[23]  J. Chiu,et al.  Prediction of relapse or survival after resection in human hepatomas by DNA flow cytometry. , 1992, The Journal of clinical investigation.

[24]  L. Sobin,et al.  The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization. , 1978, Journal of clinical pathology.

[25]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[26]  H. Bismuth,et al.  Surgical treatment of hepatocellular carcinomas in noncirrhotic liver: Experience with 68 liver resections , 2004, World Journal of Surgery.

[27]  K. Ishak,et al.  Hepatocellular carcinoma in cirrhotic and noncirrhotic livers. A clinico-histopathologic study of 804 North American patients. , 1996, American journal of clinical pathology.