Open AccessLong‐Term Survival Outcomes After Liver Resection for Binodular Hepatocellular Carcinoma: A Multicenter Cohort Study
Author(s) -
Wang MingDa,
Li Chao,
Li Jun,
Zhang WanGuang,
Jiang WeiQin,
Yu JiongJie,
Xing Hao,
Wu Han,
Han Jun,
Li ZhenLi,
Xu XinFei,
Chen TingHao,
Zhou YaHao,
Gu WeiMin,
Wang Hong,
Zeng YongYi,
Zhang YaoMing,
Pawlik Timothy M.,
Lau Wan Yee,
Wu MengChao,
Yang JiaMei,
Shen Feng,
Yang Tian
Publication year - 2019
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2018-0898
Subject(s) - medicine , hepatocellular carcinoma , perioperative , hepatectomy , proportional hazards model , nodule (geology) , cohort , oncology , resection , gastroenterology , surgery , radiology , paleontology , biology
Background The long‐term prognosis after liver resection for multinodular (≥3 nodules) hepatocellular carcinoma (HCC) is generally considered to be unfavorable. However, the role of liver resection for binodular HCC is less investigated. Subjects, Materials, and Methods From a multicenter database, consecutive patients who underwent curative‐intent liver resection for binodular HCC and without macrovascular invasion between 2003 and 2015 were retrospectively reviewed. Patients’ clinical variables as well as perioperative and long‐term survival outcomes were analyzed. Univariable and multivariable analyses were performed to identify the risk factors associated with overall survival (OS) and recurrence‐free survival (RFS) after curative resection. Results Of 263 enrolled patients, the perioperative 30‐day mortality and morbidity rates were 1.5% and 28.5%. The 1‐, 3‐, and 5‐year OS and RFS rates were 81.5%, 52.4%, and 39.1% and 57.1%, 35.8%, and 26.6%, respectively. Multivariable Cox‐regression analyses identified preoperative alpha‐fetoprotein level >400 μg/L, tumor size with a sum of two nodules >8 cm, tumor size ratio of large/small nodule >1.5 (asymmetrical proportion), unilateral hemiliver distribution of two nodules, distance of ≤3 cm between two nodules, and microvascular invasion in any nodule as independent risk factors associated with decreased OS and RFS. Conclusion Liver resection was safe and feasible in patients with binodular HCC, with acceptable perioperative and long‐term outcomes. Sum of two tumor sizes, size ratio and distribution, and distance between two nodules were independent risk factors associated with long‐term survival outcomes after surgery. These results may guide clinicians to make individualized surgical decisions and estimate long‐term prognosis for these patients. Implications for Practice Liver resection was safe and feasible in patients with binodular hepatocellular carcinoma, with acceptable perioperative and long‐term outcomes. The sum of two tumor sizes, the size ratio and distribution of the two nodules, and the distance between two nodules were independent risk factors associated with long‐term overall survival and recurrence‐free survival after liver resection. The results of this study may guide clinicians to make individualized surgical decisions, estimate long‐term prognosis, and plan recurrence surveillance and adjuvant therapy for these patients.