Factors associated with recurrence and survival following hepatectomy for large hepatocellular carcinoma: A multicenter analysis

Background Optimal management of large (>5 cm) hepatocellular carcinoma (HCC) remains controversial. We sought to determine the factors associated with recurrence and survival for patients with large HCC following hepatectomy. Methods An analysis of a combined prospective database from two tertiary care centers was performed on consecutive patients who underwent hepatectomy for HCC > 5 cm. Univariate and multivariate analyses were performed to determine factors associated with recurrence, disease‐free (DFS) and overall survival (OS). Results Seventy‐eight patients were identified: 32 (41%) had hepatic fibrosis. Forty‐six patients (59%) underwent a major hepatectomy with a morbidity rate of 41% and a mortality rate of 13%. Fibrosis was associated with male gender ( P  = 0.045), hepatitis C ( P  = 0.003), higher Child‐Pugh ( P  < 0.0001) and Okuda score ( P  = 0.002), smaller tumors (6.25 cm vs. 10.5 cm; P  < 0.001), positive‐margin resection ( P  = 0.01), and death ( P  = 0.047). Factors associated with recurrence include tumor multifocality ( P  = 0.03) and vascular invasion ( P  = 0.02). Predictors of OS include multifocal tumors ( P  = 0.05), margin status ( P  = 0.02), vascular invasion ( P  = 0.01), and treatment complications ( P  = 0.004). The median overall DFS and OS were 12 and 20 months, respectively. Fibrosis had no impact on DFS ( P  = 0.24) or OS ( P  = 0.20). Conclusions For patients with HCC larger than 5 cm, tumor‐related factors predict outcomes and survival. J. Surg. Oncol. 2010;101:105–110. © 2009 Wiley‐Liss, Inc.