Predictors of poor prognosis by recurrence patterns after curative hepatectomy for hepatocellular carcinoma in Child-Pugh classification A.
OBJECTIVE
The prevention of recurrence is important for improving long-term outcome for HCC. To identify candidates for postoperative adjuvant therapy after curative hepatectomy for HCC in Child-Pugh classification A (Child A).


METHODS
Of 157 patients who underwent initial hepatectomy for Child A HCC, 93 had recurrence and were divided into 2 groups: group A, ≤2 tumors, each <3 cm in size at the time of intrahepatic recurrence; group B, ≥3 tumors or tumor ≥3 cm in size at the time of intrahepatic recurrence and/or extrahepatic recurrence. Clinicopathological and survival data were analyzed retrospectively in each group to identify poor prognostic factors.


RESULTS
The 1-year recurrence rate was 50%, and the time to recurrence was shorter in group B (10 months) than in group A (20 months) Overall 1-, 3-, and 5-year survival rates were poorer in group B (83%, 52%, and 35% respectively; p < 0.001) than in group A (100%, 96%, and 71% respectively) Cancer spread (vascular invasion and/or intrahepatic metastasis) was significantly affecting the recurrence pattern of Group B (p=0.0238) on multivariate analysis.


CONCLUSIONS
Systemic adjuvant chemotherapy af ter curative hepatectomy for HCC in Child A should be given to patients with microscopic vascular invasion and/or intrahepatic metastasis.
Fumitoshi
F
Hirokawa
Michihiro
M
Hayashi
Yoshiharu
Y
Miyamoto
Mitsuhiro
M
Asakuma
Tetsunosuke
T
Shimizu
Koji
K
Komeda
Yoshihiro
Y
Inoue
Kazuhisa
K
Uchiyama
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden