Liver resection for early hepatocellular cancer: Comparison of centers in 3 different countries

Abstract

AIMTo compare patients who underwent resection of early stage hepatocellular cancer (HCC) in three different countries.METHODSThis retrospective study characterizes 573 stage I/II HCC patients treated with liver resection in 3 tertiary-referral centers: Tokyo (n = 250), Honolulu (n = 146) and Shanghai (n = 177).RESULTSShanghai patients were younger, predominantly male, hepatitis-B seropositive (94%) and cirrhotic (93%). Tokyo patients were older and more likely to have hepatitis-C (67%), smaller tumors, low albumin, and normal alpha-fetoprotein. The Honolulu cohort had the largest tumors and 30% had no viral hepatitis. Age-adjusted mortality at 1 and 5-years were lower in the Tokyo cohort compared to Honolulu and there was no difference in mortality between Shanghai and Honolulu cohorts. Elevated alpha-fetoprotein, low albumin and tumor > 5 cm were associated with increased 1-year mortality. These factors and cirrhosis were independently associated with increased 5-year mortality. Independent risk factors of survival varied when examined separately by center.CONCLUSIONThe profile of early-stage HCC patients is strikingly different across countries and likely contributes to survival differences. Underlying differences in patient populations including risk factors/comorbidities influencing disease progression may also account for variation in outcomes.

Clinical and molecular sub-classification of hepatocellular carcinoma relative to alpha-fetoprotein level in an Asia-Pacific island cohort

“…Reflecting its predominantly Asian and Pacific Islander demographic, Hawaii has one of the highest incidence rates of liver cancer in the US, with an age-adjusted incidence rate of 11.0 per 100,000 that is considerably higher than the overall US rate of 7.6 per 100,000 [ 4 ] . Given that the distribution of HCC risk factors in Hawaii differs from that of both Asia and the continental US [ 5 – 7 ] , studies involving cohorts from Hawaii may provide additional insights into the disease.…”

Perioperative factors related to the prognosis of elderly patients with hepatocellular carcinoma

“…Wong LL [17] reported that elevated alpha-fetoprotein levels, low levels of albumin and tumours > 5 cm in size were associated with increased 1-year mortality after hepatic resection for early-stage hepatocellular cancer in a retrospective study. Kondo K [18] reported that alkaline phosphatase (ALP, > 125 U/L), alpha-fetoprotein (AFP, within 20-400 or > 400 ng/mL), protein induced by vitamin K absence-II (PVIKA-II, within 40-400 or > 400 mAU/mL), tumour number, diameter, pseudocapsule, tumour growth pattern and intratumour haemorrhage were independent prognostic factors for hepatocellular carcinoma patients.…”