Open AccessPrognostic significance of anatomical resection and des‐γ‐carboxy prothrombin in patients with hepatocellular carcinoma
Author(s) -
Imamura H.,
Matsuyama Y.,
Miyagawa Y.,
Ishida K.,
Shimada R.,
Miyagawa S.,
Makuuchi M.,
Kawasaki S.
Publication year - 1999
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.1999.01185.x
Subject(s) - medicine , hepatocellular carcinoma , hepatectomy , proportional hazards model , resection margin , surgical margin , metastasis , hazard ratio , retrospective cohort study , pathological , gastroenterology , radiology , surgery , resection , cancer , confidence interval
Background: Portal venous tumour extension and intrahepatic metastasis result in a poor prognosis following hepatectomy for hepatocellular carcinoma (HCC). Anatomical resection is, in theory, preferable for eradicating these types of invasion. Des‐γ‐carboxy prothrombin (DCP) has been reported to be associated with adverse pathological variables. This study investigated the significance of anatomical resection and DCP as predictive factors for postoperative recurrence of HCC. Methods: A retrospective cohort study was carried out in 138 consecutive patients who underwent hepatectomy for HCC smaller than 5 cm using the Cox proportional hazards model. Results: Eight factors were univariately related to poor prognosis (in decreasing order of hazard ratio): intrahepatic metastasis, multiple tumours, α‐fetoprotein 32 ng/ml or more; DCP greater than 0·1 arbitrary units (AU), tumour‐exposed surgical margin, vascular invasion, non‐anatomical resection and tumour 2·5 cm or more. Three variables (DCP, vascular invasion and tumour‐exposed surgical margin) were excluded by a stepwise procedure in multivariate analysis. Although DCP was not an independent prognostic factor, a model replacing intrahepatic metastasis with DCP showed similar predictive accuracy in a receiver‐operating characteristic curve. Conclusion: Anatomical resection appeared to have a beneficial effect on recurrence‐free survival after hepatectomy for HCC. DCP measurement was effective in predicting HCC recurrence and had the advantage that it can be assessed before operation. © 1999 British Journal of Surgery Society Ltd