Clinicopathological Risk Factors for Recurrence within One Year after Initial Hepatectomy for Hepatocellular Carcinoma

• Published in: The American surgeon 2011-05, Vol.77 (5), p.572-578
• Main Authors: HAYASHI, Michihiro, SHIMIZU, Tetsunosuke, HIROKAWA, Fumitoshi, INOUE, Yoshihiro, KOMEDA, Koji, ASAKUMA, Mitsuhiro, MIYAMOTO, Yoshiharu, TAKESHITA, Atsushi, SHIBAYAMA, Yuro, TANIGAWA, Nobuhiko
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; alpha-Fetoproteins - metabolism; Biological and medical sciences; Biomarkers - metabolism; Biomarkers, Tumor - blood; Biopsy, Needle; Cancer; Carcinoma, Hepatocellular - blood; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Cohort Studies; Disease-Free Survival; Epidemiology; Female; General aspects; Hepatectomy - methods; Hepatectomy - mortality; Hepatitis; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Liver cancer; Liver cirrhosis; Liver Neoplasms - blood; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Logistic Models; Male; Medical imaging; Medical sciences; Middle Aged; Mortality; Multivariate Analysis; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Predictive Value of Tests; Preoperative Care - methods; Prognosis; Protein Precursors - metabolism; Prothrombin - metabolism; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Assessment; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Time Factors
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481107700516

Hepatocellular carcinoma (HCC) shows a high rate of recurrence after hepatectomy; predictive factors for early recurrence would help determine optimal therapeutic and management strategies. Among 163 patients with HCC undergoing hepatectomy with curative intent, 46 patients developed recurrence within 1 year. Clinicopathological data were retrospectively analyzed to identify predictive parameters for early recurrence. Survival rates in cases of recurrence within 1 year were worse than those of no recurrence within 1 year or recurrence after 1 year. Protein induced by vitamin K absence/antagonist II (PIVKA-II) greater than 150, positive fucosylated alpha-fetoprotein (L3-AFP), and deviancy from Milan criteria (MC) on preoperative imaging were associated with high risk of early recurrence and total number of these three risk factors predicted the survival. With multivariate analysis, (1) preoperatively, positive factors of two or more among three items of PIVKA-II, L3-AFP, and deviancy from MC; (2) and postoperatively, pathological cancer spread (microscopic vascular invasion and/or intrahepatic metastasis) both represented risks for early recurrence. A combination of three preoperative factors, PIVKA-II, L3-AFP, and MC status, in conjunction with the postoperative factor of cancer spread status represents a significant indicator for recurrence within 1 year. Improving the prognosis of patients with HCC would depend on how to adequately treat those at high risk of early recurrence.