title: Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years.
abstract: OBJECTIVE
  To investigate whether the survival results after resection of hepatocellular carcinoma (HCC) have improved within the past decade by an analysis of a prospective cohort of patients over a 10-year period.
  
  
  BACKGROUND
  The surgical death rate after resection of HCC has greatly improved in recent years, but the long-term prognosis remains unsatisfactory. It remains unknown whether the survival results after resection of HCC have improved within the past decade.
  
  
  METHODS
  The clinicopathologic and follow-up data of 377 patients who underwent curative resection of HCC between January 1989 and January 1999 were prospectively collected. These patients were categorized according to two time periods: before 1994 (group 1, n = 136) and after 1994 (group 2, n = 241). The two groups were compared for clinicopathologic data and survival results. The prognostic factors for disease-free survival were further analyzed to identify the factors that might have led to improved survival outcomes.
  
  
  RESULTS
  The overall and disease-free survival results were significantly better in group 2 compared with group 1. Patients in group 2 had significantly higher proportions of subclinical presentation, small tumors, and tumors of early pTNM stage. There were also significantly lower frequencies of histologic margin involvement, less intraoperative blood loss, and a lower transfusion rate in group 2. By multivariate analysis, early pTNM stage, subclinical HCC, and no perioperative transfusion were independent favorable prognostic factors for disease-free survival.
  
  
  CONCLUSIONS
  Significant improvement of overall and disease-free survival results after resection of HCC has been achieved within the past decade as a result of advances in the diagnosis and surgical management of HCC. Earlier diagnosis of HCC by better imaging modalities, increased detection of subclinical HCC by screening of high-risk patients, and a reduced perioperative transfusion rate were identified as the major contributory factors for the improved outcomes.
authors: Centre for the Study of Liver Disease, Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China.
authors: R T
authors: RT
authors: Poon
authors: S T
authors: ST
authors: Fan
authors: C M
authors: CM
authors: Lo
authors: I O
authors: IO
authors: Ng
authors: C L
authors: CL
authors: Liu
authors: C M
authors: CM
authors: Lam
authors: J
authors: J
authors: Wong
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies