Preoperative predictors of survival after resection of small hepatocellular carcinomas.
OBJECTIVE
To determine preoperative predictors of survival that can guide the choice of treatment for patients with small hepatocellular cancers (HCCs).


BACKGROUND
The treatment of patients with small (</=5 cm in diameter) HCCs is controversial.


METHODS
A cohort of 249 patients (69 women, 180 men; median age 62 years) who underwent resection with curative intent for small HCC was identified from a multiinstitutional database. For each patient, the clinical data and pathology slides were reviewed. Six clinical factors (age, gender, preoperative alpha-fetoprotein level, hepatitis serology, number of tumors [single vs. multiple], and Child-Pugh score) and three pathologic factors (hepatitis activity score, fibrosis score, and Edmondson-Steiner tumor grade) that can be determined before surgery were correlated with survival. Log-rank tests and Cox proportional hazards modeling were used to determine factors influencing survival.


RESULTS
The median overall survival for the entire cohort was 4.2 years. The estimated overall 5- and 8-year survival rates were 41.1% and 19.8%, respectively. Multivariate Cox analysis indicated that fibrosis score, Edmondson-Steiner grade, and Child-Pugh score were simultaneously significant predictors of survival after resection. A prognostic scoring system based on these covariates was derived and applied to the entire cohort. Patients lacking all three risk factors were assigned a score of 1, patients with one risk factor were assigned a score of 2, and patients with two or three risk factors were assigned a score of 3. Pairwise log-rank tests indicated significant differences in survival between scores 1 and 2, scores 2 and 3, and scores 1 and 3. This scoring system retained its prognostic significance when a subset of 98 patients with positive hepatitis C serology was analyzed separately.


CONCLUSIONS
Patients with small HCCs who will derive the least benefit from resection can be identified before surgery using a score based on tumor grade and the severity of underlying liver disease. In these patients, transplantation and/or ablation should be considered as possible alternative therapies.
Wayne
Jeffrey D
JD
International Cooperative Study Group on Hepatocellular Carcinoma: Department of Surgical Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Lauwers
Gregory Y
GY
Ikai
Iwao
I
Doherty
Dorota A
DA
Belghiti
Jacques
J
Yamaoka
Yoshio
Y
Regimbeau
Jean-Marc
JM
Nagorney
David M
DM
Do
Kim-Anh
KA
Ellis
Lee M
LM
Curley
Steven A
SA
Pollock
Raphael E
RE
Vauthey
Jean-Nicolas
JN
D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis