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Cirrhosis and microvascular invasion predict outcomes in hepatocellular carcinoma
Author(s) -
Barreto Savio G.,
BrookeSmith Mark,
Dolan Paul,
Wilson Thomas G.,
Padbury Robert T. A.,
Chen John W. C.
Publication year - 2013
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2012.06196.x
Subject(s) - medicine , hepatocellular carcinoma , cirrhosis , gastroenterology , liver transplantation , vascular invasion , multivariate analysis , overall survival , carcinoma , surgery , transplantation
Background Liver resection ( LR ) and liver transplantation ( LT ) are two modalities offering potential for cure in patients with hepatocellular carcinoma ( HCC ). The objective of this study was to evaluate the long‐term survival of patients with HCC treated with LT and LR and to analyse variables influencing these outcomes. Methods Patients referred to the S outh A ustralian L iver T ransplant U nit and H epatopancreatobiliary U nit at F linders M edical C entre from J anuary 1992 to S eptember 2009 with a diagnosis of HCC who underwent LT or LR were included in the study. Histopathological parameters analysed included size, number and grade of tumour, microscopic vascular invasion and presence or absence of cirrhosis in remnant liver. Results Eighty‐five patients with a median age of 58 years (range 26–85 years) underwent LT or LR . Median follow‐up was 40 months in both groups. Overall, 5‐year actuarial survival for all patients with HCC in both groups was 55%. LR patients were significantly older ( P < 0.001) than LT patients. Their tumours were larger ( P < 001) and more often solitary ( P < 0.001) compared with the LT group. In multivariate analysis, age >60 ( P < 0.02), histopathological evidence of vascular invasion ( P < 0.02) and presence of cirrhosis ( P < 0.02) were associated with a significantly reduced survival. Patients without vascular invasion and cirrhosis had an actuarial 5‐year survival >70%. Conclusions Our study indicates that LT (within U niversity of C alifornia, S an F rancisco criteria) and LR can lead to acceptable long‐term survival outcomes in patients with HCC . Microscopic vascular invasion and cirrhosis were the most significant prognostic factors impacting on survival.