title: Long-term outcomes and prognostic factors with reductive hepatectomy and sequential percutaneous isolated hepatic perfusion for multiple bilobar hepatocellular carcinoma.
abstract: BACKGROUND
  Sorafenib is currently recommended as first-line therapy for patients with intermediate or advanced hepatocellular carcinoma (HCC) per Barcelona Clinic Liver Cancer staging. However, the median overall survival (OS) with sorafenib in these patients is 10.7 months with an overall response rate of 2 %. We retrospectively investigated the long-term outcomes and prognostic factors with reductive hepatectomy and sequential percutaneous isolated hepatic perfusion (PIHP) for refractory intermediate or advanced HCC.
  
  
  METHODS
  A total of 68 patients who had intermediate or advanced stage HCC without extrahepatic metastases were scheduled for reductive hepatectomy plus PIHP. All patients underwent reductive hepatectomy and PIHP with mitomycin C 20-40 mg/m(2) and/or doxorubicin 60-120 mg/m(2) 1-3 months after surgery (mean, 1.51 times/patient).
  
  
  RESULTS
  The objective response rate of PIHP was 70.6 % (complete plus partial response). The median OS of all 68 patients was 25 months, and the 5-year OS rate was 27.6 %. Univariate and multivariate analyses indicated that tumor response to PIHP and normalization of serum des-γ-carboxy prothrombin concentrations after PIHP were independent prognostic factors for OS.
  
  
  CONCLUSIONS
  The median OS of the study population treated by reductive hepatectomy and sequential PIHP was 25 months. This treatment strategy can offer a possible curative treatment to patients with refractory intermediate and advanced HCC.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tominaga
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kido
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takebe
authors.forename: Motofumi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Kaori
authors.initials: K
authors.lastname: Kuramitsu
authors.forename: Ippei
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ajiki
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D016685:Mitomycin; D004317:Doxorubicin