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Factors associated with recurrence and survival following hepatectomy for large hepatocellular carcinoma: A multicenter analysis
Author(s) -
Schiffman Suzanne C.,
Woodall Charles E.,
Kooby David A.,
Martin Robert C.G.,
Staley Charles A.,
Egnatashvili Vasili,
McMasters Kelly M.,
Scoggins Charles R.
Publication year - 2010
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21461
Subject(s) - medicine , hepatocellular carcinoma , hepatectomy , gastroenterology , univariate analysis , multivariate analysis , surgical margin , carcinoma , prospective cohort study , surgery , oncology , resection , cancer
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.