Poor prognostic factors of hepatectomy in patients with resectable small hepatocellular carcinoma and cirrhosis.
OBJECTIVE
Some patients with hepatocellular carcinoma (HCC) at an early stage cannot attain long-term survival after hepatectomy. The aim of the present study was to investigate the poor prognostic factors for hepatectomy in patients with resectable small HCC with cirrhosis.


METHODS
We studied 95 patients with cirrhosis with HCC, which consisted of a single tumor 5 cm or smaller or two or three tumor nodules each 3 cm or less; an absence of extrahepatic metastasis; and an absence of radiological evidence of macroscopic portal vein or hepatic vein invasion. We used Cox's proportional hazard model to identify risk factors associated with prognosis to determine the contra-indications for hepatectomy in patients with resectable small HCC.


RESULTS
Preoperative risk factors were: (1) serum AFP concentration of more than 400 ng/ml; (2) infiltrative-, massive-, or multinodular-type (multiple) HCC; and (3) the presence of intrahepatic metastasis. Patients who had had more than one of the three preoperative risk factors were poor candidates for hepatic resection, with a 4-year survival of 16.3%.


CONCLUSIONS
If patients with resectable small HCC are diagnosed as having more than one of three preoperative risk factors, they should not receive hepatectomy or should be considered for primary liver transplantation as a therapeutic option for HCC.
Ochiai
Toshia
T
Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Hirokoji-kawaramachi, Kamigyo-ku, 602-8566, Japan. tochiai@koto.kpu-m.ac.jp
Sonoyama
Teruhisa
T
Ichikawa
Daisuke
D
Fujiwara
Hitoshi
H
Okamoto
Kazuma
K
Sakakura
Chohei
C
Ueda
Yuji
Y
Otsuji
Eigo
E
Itoi
Hirosumi
H
Hagiwara
Akeo
A
Yamagishi
Hisakazu
H
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000075202:Contraindications; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors