Experience of 1000 patients who underwent hepatectomy for small hepatocellular carcinoma

Abstract

BACKGROUND Recently, the implementation of screening programs using α‐fetoprotein (AFP) and ultrasonography in high risk populations has identified increasing numbers of patients with small hepatocellular carcinoma (small HCC). The aim of this study was to summarize the authors' experience in patients who underwent hepatectomy for small HCC and the factors that influence or improve long term survival. METHODS The study included 1000 patients who underwent hepatectomy for small HCC (≤ 5 cm) and compared them with 1366 patients who underwent hepatectomy for large HCC (> 5 cm) during the same period. A Cox proportional‐hazards model was used for multivariate analysis of prognostic factors. RESULTS Comparison between patients with small HCC (n = 1000 patients) and patients with large HCC (n = 1366 patients) revealed that those with small HCC had a higher resection rate (93.6% [1000 of 1068 patients] vs. 55.7% [1366 of 2451 patients]; P < 0.01), a higher curative resection rate (80.5% [805 of 1000 patients] vs. 60.7% [829 of 1366 patients]; P < 0.01), a lower operative mortality rate (1.5% [15 of 1000 patients] vs. 3.7% [50 of 1366 patients]; P < 0.01), better differentiation of tumor cells (Edmondson Grade 3–4; 14.9% vs. 20.1%; P < 0.01), a higher incidence of single nodule tumors (82.6% vs. 64.4%; P < 0.01), a higher proportion of well encapsulated tumors (73.3% vs. 46.3%; P < 0.01), a lower incidence of tumor emboli in the portal vein (4.9% vs. 20.8%; P < 0.01), and higher survival rates after undergoing resection (5 years: 62.7% vs. 37.1%; P < 0.01; 10 years: 46.3% vs. 29.2%; P < 0.01). No significant difference was found between survival after undergoing minor resection (n = 949 patients) or lobectomy (n = 51 patients) in patients with small HCC (P > 0.05). Reresection for subclinical recurrence or solitary pulmonary metastasis after small HCC resection was undertaken in 84 patients. CONCLUSIONS Resection is still the modality of first choice for the treatment of patients with small HCC. Minor resection instead of lobectomy was the key to increasing resectability and decreasing operative mortality, and reresection for subclinical recurrence or solitary pulmonary metastasis was important approach to prolonging survival further. Cancer 2001;91:1479–86. © 2001 American Cancer Society.

Prognostic significance of c‐myc and AIB1 amplification in hepatocellular carcinoma

“…Tumor size is considered an important factor that influences the long-term survival rate of patients with HCC after they undergo hepatectomy. 24 It has been reported that the percentage of poorly differentiated tumor cells is higher in large HCC tumors; therefore, proliferative activity and Edmondson grade often were higher in large HCC tumors. 25 However, the cytogenetic alterations that contribute to this feature remain obscure.…”

Expression level of glutamine synthetase is increased in hepatocellular carcinoma and liver tissue with cirrhosis and chronic hepatitis B

“…Asymptomatic patients with early HCC who have negative serum markers (AFP and PIVKA-II) are usually not diagnosed until the advanced stage. Early diagnosis of HCC could greatly improve the outcome of surgical treatments for HCC, with better long-term survival and reduced recurrence risk [3]. Therefore, search for effective markers for HCC is a field of intense research.…”

Phase II Randomized Trial of Autologous Formalin-Fixed Tumor Vaccine for Postsurgical Recurrence of Hepatocellular Carcinoma

“…Vaccination with hepatitis B surface antigen and IFN therapy for hepatitis C may reduce the incidence of HCC in the future (3,4), but effective treatment for HCC in hepatitis-prevalent countries such as China, where one-third of new cases arise (5,6), is urgently needed. Curative treatments such as hepatic resection, orthotopic liver transplantation, or percutaneous regional treatments offer the only chance of cure, but most cases are ineligible at diagnosis due to advanced tumor stage or poor liver function (6 -14).…”

“…Curative treatments such as hepatic resection, orthotopic liver transplantation, or percutaneous regional treatments offer the only chance of cure, but most cases are ineligible at diagnosis due to advanced tumor stage or poor liver function (6 -14). Furthermore, the high frequency of postoperative recurrence decreases the long-term survival rate (5)(6)(7)(8)(9)(10)(11)(12).…”