title: Continuous improvement of survival outcomes of resection of hepatocellular carcinoma: a 20-year experience.
abstract: OBJECTIVE
  To investigate the trend of the posthepatectomy survival outcomes of hepatocellular carcinoma (HCC) patients by analysis of a prospective cohort of 1198 patients over a 20-year period.
  
  
  BACKGROUND
  The hospital mortality rate of hepatectomy for HCC has improved but the long-term survival rate remains unsatisfactory. We reported an improvement of survival results 10 years ago. It was not known whether there has been further improvement of results in recent years.
  
  
  METHODS
  The patients were categorized into two 10-year periods: period 1, before 1999 (group 1, n = 390) and period 2, after 1999 (group 2, n = 808). Patients in group 2 were managed according to a modified protocol and technique established in previous years.
  
  
  RESULTS
  The patients in group 2 were older and had a higher incidence of comorbid illness and cirrhosis. They had a lower hospital mortality rate (3.1% vs 6.2%, P = 0.012) and longer 5-year overall survival (54.8% vs 42.1%, P < 0.001) and disease-free survival rates (34.8% vs 24%, P = 0.0024). An improvement in the overall survival rate was observed in patients with cirrhosis, those undergoing major hepatectomy, and those with tumors of tumor-node-metastasis stages II, IIIA, and IVA. A significant increase in the survival rates was also seen in patients whose tumors were considered transplantable by the Milan criteria (72.5% vs 62.7%, P = 0.0237). Multivariate analysis showed a significantly more favorable patient survival for hepatectomy in period 2.
  
  
  CONCLUSIONS
  A continuous improvement of survival outcomes after hepatectomy for HCC was achieved in the past 20 years even in patients with advanced diseases. Hepatectomy remains the treatment of choice for resectable HCC in a predominantly hepatitis B virus-based Asian population.
authors.affiliation: State key Laboratory for Liver Research, the University of Hong Kong, Pokfulam, Hong Kong. stfan@hku.hk
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Chung
authors.initials: C
authors.lastname: Mau Lo
authors.forename: Ronnie T P
authors.initials: RT
authors.lastname: Poon
authors.forename: Chun
authors.initials: C
authors.lastname: Yeung
authors.forename: Chi
authors.initials: C
authors.lastname: Leung Liu
authors.forename: Wai Key
authors.initials: WK
authors.lastname: Yuen
authors.forename: Chi
authors.initials: C
authors.lastname: Ming Lam
authors.forename: Kelvin K C
authors.initials: KK
authors.lastname: Ng
authors.forename: See
authors.initials: S
authors.lastname: Ching Chan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006723:Hong Kong; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult