Resection of hepatocellular carcinoma in patients without cirrhosis

Smoot, Rory L.; Nagorney, David M.; Chandan, Vishal S.; Que, Florencia G.; Schleck, Cathy D.; Harmsen, William S.; Kendrick, Michael L.

doi:10.1002/bjs.7401

Cited by 36 publications

(33 citation statements)

References 23 publications

(28 reference statements)

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“…1,4,12,13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Yet, no previous reports have assessed long-term outcomes between patients with NASH and other CLDs within a framework of multimodal curative therapy, including liver transplantation, resection, and ablation. Thus, the aim of this study was to determine the differences in clinical presentation, histopathology, and survival outcomes among patients undergoing any curative therapy for HCC in the setting of NASH compared to hepatitis C (HCV) and/or alcoholic liver disease (ALD).…”

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confidence: 99%

Outcomes of curative treatment for hepatocellular cancer in nonalcoholic steatohepatitis versus hepatitis C and alcoholic liver disease

et al. 2012

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Concomitant increasing incidences of hepatocellular carcinoma (HCC) and nonalcoholic steatohepatitis (NASH) suggest that a substantial proportion of HCC arises as a result of hepatocellular injury from NASH. The aim of this study was to determine differences in severity of liver dysfunction at HCC diagnosis and long-term survival outcomes between patients undergoing curative therapy for HCC in the background of NASH compared to hepatitis C virus (HCV) and/or alcoholic liver disease (ALD). Patient demographics and comorbidities, clinicopathologic data, and long-term outcomes among patients who underwent liver transplantation, hepatic resection, or radiofrequency ablation for HCC were reviewed. From 2000 to 2010, 303 patients underwent curative treatment of HCC; 52 (17.2%) and 162 (53.5%) patients had NASH and HCV and/or alcoholic liver disease. At HCC diagnosis, NASH patients were older (median age 65 versus 58 years), were more often female (48.1% versus 16.7%), more often had the metabolic syndrome (45.1% versus 14.8%), and had lower model for end-stage liver disease scores (median 9 versus 10) (all P < 0.05). NASH patients were less likely to have hepatic bridging fibrosis or cirrhosis (73.1% versus 93.8%; P < 0.001). After a median follow-up of 50 months after curative treatment, the most frequent cause of death was liver failure. Though there were no differences in recurrence-free survival after curative therapy (median, 60 versus 56 months; P 5 0.303), NASH patients had longer overall survival (OS) (median not reached versus 52 months; P 5 0.009) independent of other clinicopathologic factors and type of curative treatment. Conclusion: Patients with HCC in the setting of NASH have less severe liver dysfunction at HCC diagnosis and better OS after curative treatment compared to counterparts with HCV and/or alcoholic liver disease. (HEPATOLOGY 2012;55:1809-1819 C oncomitant increases in the incidence of hepatocellular carcinoma (HCC) and prevalence of nonalcoholic fatty liver disease (NAFLD) suggest that a substantial proportion of HCC arises as a result of hepatocellular injury from nonalcoholic steatohepatitis (NASH). As a result, HCC is the most rapidly increasing cause of cancer death in the United States.

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Outcomes of curative treatment for hepatocellular cancer in nonalcoholic steatohepatitis versus hepatitis C and alcoholic liver disease

et al. 2012

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“…32 The median DFS time was 2.4 years; the 5-year OS and DFS rates were 38% and 42%, respectively. Despite a mean tumor diameter of 10.3 cm, macrovascular invasion and microvascular invasion were present in only 13% and 8% of the cases, respectively.…”

Section: Resultsmentioning

confidence: 90%

“…Liver Resection [7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Table 1) The articles reviewed for information on partial liver resection for NC-HCC include 2263 patients; the numbers of patients in these series range from 20 to 254. [7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The results of the French multicenter ...…”

Section: Resultsmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The results of the French multicenter study, 1 which includes the world's largest series of resections for HCC arising in normal livers (ie, nonfibrotic and noncirrhotic), are discussed separately. The larger studies come from regions with high rates of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections.…”

Section: Resultsmentioning

confidence: 99%

“…Because 75% of the recurrences occurred in the liver, we can rightly address whether LT would have been a better treatment for the high-risk patients. 32 The aforementioned risk criteria and considerations could be used preoperatively to identify which patients would most likely benefit from surgery and eventually from primary or salvage transplantation and which ones would be suitable candidates for adjuvant therapy.…”

Section: Resultsmentioning

confidence: 99%

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Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

et al. 2011

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Hepatocellular carcinoma (HCC) is a relatively common cancer and occurs mainly in patients with liver cirrhosis (85%-95%). A significant number of cases are, however, diagnosed in normal and noncirrhotic/nonfibrotic livers. In contrast to HCC in a cirrhotic liver, noncirrhotic hepatocellular carcinoma (NC-HCC) predominantly occurs in young and healthy female patients in their 30s, and the diagnosis is frequently made at an advanced stage in the absence of a clear etiological factor. [1][2][3] The same holds true for the uncommon fibrolamellar hepatocellular carcinoma (FL-HCC) variant. [1][2][3] Several studies have shown that the 3-year overall survival (OS) rates with different pharmaceutical, radiological, and surgical therapies for HCC (if they are adequately performed) are approximately 60%. 4 After 3 years, the results of these treatments start to diverge substantially with respect to OS and, most importantly, with respect to disease-free survival (DFS). Long-term follow-up (5-10 years) has clearly shown that surgical resection is the only curative treatment for any kind of HCC. [2][3][4][5] With respect to very long-term DFS (>5 years), liver transplantation (LT) offers the best results. 2,4-6 In order to be successful, surgery has to be adapted to the tumor, the underlying condition of the patient, and the patient's liver. Liver resection and LT should have complementary roles rather than competing ones, and they should be associated with each other instead of being opposed. 5 Partial resection for HCC can be considered only for patients with well-compensated cirrhosis or fibrosis or with normal liver tissue. For patients with decompensated liver disease, cirrhosis, or a technically unresectable tumor, LT offers the best chance for a cure. This option indeed addresses the tumor as well as the underlying liver disease.Despite the extensive experience with LT for the treatment of HCC in patients with cirrhosis, the experience with LT for the treatment of NC-HCC is anecdotal and is limited to situations in which resection is not possible.The aims of this study were as follows: (1) to analyze the results from recent series of partial liver resections for NC-HCC, (2) to compare these results with the results of LT for the same condition; and (3) to propose an adaptation of the therapeutic algorithm for NC-HCC on the basis of these analyses.

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Cardiopulmonary exercise testing for preoperative risk assessment before hepatic resection

Junejo

Mason

Sheen

et al. 2012

British Journal of Surgery

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Resection of hepatocellular carcinoma in patients without cirrhosis

Abstract: Patients with HCC but without cirrhosis have acceptable outcomes after resection. Specific risk factors for the development of HCC in these patients have yet to be defined.

Cited by 36 publications

References 23 publications

Outcomes of curative treatment for hepatocellular cancer in nonalcoholic steatohepatitis versus hepatitis C and alcoholic liver disease

Outcomes of curative treatment for hepatocellular cancer in nonalcoholic steatohepatitis versus hepatitis C and alcoholic liver disease

Place of liver transplantation in the treatment of hepatocellular carcinoma in the normal liver

Cardiopulmonary exercise testing for preoperative risk assessment before hepatic resection

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