Prognostic impact of surgical complications and preoperative serum hepatocyte growth factor in hepatocellular carcinoma patients after initial hepatectomy.
BACKGROUND
The relationship between postoperative complications and survival after hepatectomy is not completely understood. The purpose of this study was to determine if surgical complications would have a prognostic impact and to identify any difference of the prognostic factors between a complication group and complication-free group for hepatocellular carcinoma (HCC) patients after initial hepatectomy.


METHODS
One hundred consecutive HCC patients were analyzed in this study. Operative variables and liver functional markers were compared between the complication group and complication-free group. The diagnostic accuracy for predicting complications was evaluated by the receiver operating characteristic (ROC) curve. The Kaplan-Meier method with log-rank test was employed for survival analysis. Univariate and multivariate analyses were performed to identify the prognostic factors in each group.


CONCLUSIONS
A total of 45 complications in 32 patients were observed according to the modified Clavien classification. The albumin, gamma-glutamyl transferase, choline esterase, indocyanine green retention rate at 15 min (ICGR(15)), hyaluronic acid, prealbumin, hepatocyte growth factor (HGF), HH15, and LHL15 levels before hepatectomy, operative time, and blood loss were significantly different between the two groups. Multivariate analysis revealed that gamma-glutamyl transferase, ICGR(15), and HGF were independent risk factors for postoperative complications. The values of the areas under the ROC curve for predicting complications proved the significance of the predictions. Although the recurrence-free survival rates were not significantly different, the overall survival rates were significantly different between the two groups. Univariate and multivariate analyses for the overall survival rate showed that the stage of the HCC and HGF for the complication group and tumor size for the complication-free group were independent prognostic factors for overall survival.


CONCLUSIONS
Postoperative surgical complications could have a prognostic impact on overall survival in HCC patients after initial hepatectomy. Serum HGF could be a factor connected to complications and survival in this group.
Department of Surgery I, School of Medicine, Sapporo Medical University, S-1, W-16, Chuo-Ku, Sapporo, Hokkaido 060-8543, Japan. tmizu@sapmed.ac.jp
Toru
T
Mizuguchi
Minoru
M
Nagayama
Makoto
M
Meguro
Toshihito
T
Shibata
Shinsuke
S
Kaji
Takayuki
T
Nobuoka
Yasutoshi
Y
Kimura
Tomohisa
T
Furuhata
Koichi
K
Hirata
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D017228:Hepatocyte Growth Factor / Q000097:blood*; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
D017228:Hepatocyte Growth Factor