title: Twenty-year survivors after resection for hepatocellular carcinoma-analysis of 53 cases.
abstract: OBJECTIVE
  To clarify the clinicopathologic features of patients surviving > or =20 years after resection for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Between 1961 and 1987, a total of 396 patients underwent hepatic resection for HCC; 53 (13.4%) patients survived > or =20 years, and 343 (86.6%) patients survived <20 years. A comparative study between the two groups was made.
  
  
  RESULTS
  By March of 2007, 67.6% (36/53) patients are still alive, disease free; 5.7% (3/53) patients died of tumor recurrence or metastasis; 11.3% (6/53) patients died of liver failure; 5.7% (5/53) patients were lost during follow-up. The longest patient survived 43 years and 2 months. Five young patients got married after resection and have had babies. One patient with a tumor measuring 17 x 13 x 9 cm (largest tumor in this series) survived for 37 years after resection, still alive, free of disease. Reresection for recurrence was done in nine patients, mean survival being 26 years and 11 months. Reresection for solitary pulmonary metastasis was carried out in three patients, mean survival being 29 years and 2 months. In comparison with patients surviving <20 years, patients surviving > or =20 years were significantly younger (P = 0.031), had a higher incidence of asymptomatic tumors (56.6 vs. 34.4%, P = 0.002); lower gamma-glutamyl transpeptidase level (< or =50 U/L, 64.2 vs. 25.9%, P < 0.000), lower proportion of liver cirrhosis (66.0 vs. 83.6%, P = 0.002); higher percentage of small tumors (< or =5 cm, 62.3 vs. 29.9%, P < 0.000), single nodule tumors (90.6 vs. 62.9%, P < 0.000), and well-encapsulated tumors (86.8 vs. 43.6%, P < 0.000); lower proportion of tumor emboli in the portal vein (3.8 vs. 22.5%, P = 0.002), better differentiation of tumor cells (Edmondson grade I, 21.6 vs. 9.1%, P = 0.036), and higher curative resection rate (100 vs. 64.1%, P < 0.000).
  
  
  CONCLUSIONS
  Early detection and curative resection are the principal factors improving long-term survival. Long-term follow-up after resection of HCC is very important, and should continue for the remainder of the patient's life. Reresection for recurrence and metastasis is important approach to improve prognosis.
authors.affiliation: Liver Cancer Institute, Zhong Shan Hospital, Fudan University, 136 Yi Xue Yuan Road, 200032 Shanghai, China. xdzhou2000@yahoo.com.cn
authors.forename: Xin-Da
authors.initials: XD
authors.lastname: Zhou
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
authors.forename: Zeng-Chen
authors.initials: ZC
authors.lastname: Ma
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.forename: Zhi-Quan
authors.initials: ZQ
authors.lastname: Wu
authors.forename: Lun-Xiu
authors.initials: LX
authors.lastname: Qin
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.forename: Yao
authors.initials: Y
authors.lastname: Yu
authors.forename: Hui-Chuan
authors.initials: HC
authors.lastname: Sun
authors.forename: Shuang-Jian
authors.initials: SJ
authors.lastname: Qiu
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013514:Surgical Procedures, Operative; D017741:Survivors / Q000706:statistics & numerical data*