title: Indication of hepatectomy for cirrhotic patients with hepatocellular carcinoma classified as Child-Pugh class B.
abstract: We clarified the indication of partial hepatectomy in hepatocellular carcinoma (HCC) patients with liver cirrhosis classified as Child-Pugh class B. Univariate analysis revealed that adverse prognostic factors were (1) the presence of ascites, (2) elevated total bilirubin (1.5 mg/dl or higher), (3) reduced choline esterase (160 IU/ or lower), (4) elevated alpha-fetoprotein (AFP) (400 ng/ml or higher), (5) microscopic vascular invasion, and (6) non-curative hepatectomy. Microvascular invasion was excluded in the multivariate analysis because this factor could not be predicted before hepatectomy. Multivariate analysis revealed that independent adverse prognostic factors were (1) elevated total bilirubin (1.5 mg/dl or higher), (2) presence of ascites, (3) elevated AFP (400 ng/ml or higher), and (4) non-curative hepatectomy. The overall 5-year survival rate of patients with none of or only one of the four adverse prognostic factors was 45.8%. The overall 5-year survival rate of patients with two or more adverse prognostic factors was only 7.0%. Partial hepatectomy is the first choice of treatment for patients with none of or only one of the four adverse prognostic factors, whereas orthotopic liver transplantation or other conservative treatment should be considered for patients with two or more adverse prognostic factors.
authors.affiliation: Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. h-nakahara@hph.pref.hiroshima.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakahara
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Itamoto
authors.forename: Koji
authors.initials: K
authors.lastname: Katayama
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hino
authors.forename: Makoto
authors.initials: M
authors.lastname: Ochi
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tashiro
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Asahara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome