An analysis of 412 cases of hepatocellular carcinoma at a Western center

Abstract

Objective: Using a large single-institution experience at a Western referral center, the authors examine partial hepatectomy as treatment of hepatocellular carcinoma and relate treatment outcomes to clinical parameters, including the etiology of underlying cirrhosis.

Methods: Four hundred and twelve patients seen between December 1991 and January 1998 were identified in a prospective database. Data about the surgical procedure, perioperative complications, and long-term outcome were examined.

Results: One hundred twenty-six patients did not have underlying cirrhosis. Of the 286 patients with cirrhosis, 119 were the result of hepatitis B, 39 hepatitis C, 36 both B and C, 43 ethanol abuse, and the remainder other causes. Two hundred forty-three patients underwent surgical exploration, and 154 patients underwent hepatic resection. Seven (4.5%) died from the surgery. One hundred forty-three patients were treated by ablative methods. Patients with cirrhosis had smaller tumors but nevertheless had a lower resectability rate. Neither the presence of cirrhosis nor the etiology of the cirrhosis altered the perioperative morbidity or mortality rate. The greatest determinant of long-term outcome was resectability. The size of the lesion, an alpha-fetoprotein level >2000 ng/ml, and vascular invasion were also determinants of poor outcome. The presence of cirrhosis was a detrimental factor when analysis was stratified for size of tumor. The cause of cirrhosis did not influence the long-term outcome. The 5-year survival rate was 57% for patients with resected lesions <5 cm and 32% for patients with tumors >10 cm.

Conclusion: Partial hepatectomy is safe, effective, and potentially curative therapy for hepatocellular carcinoma. The presence of cirrhosis did not affect the surgical mortality rate but did affect the long-term survival rate. The cause of cirrhosis did not influence outcome. As treatment for small hepatocellular carcinomas, partial hepatectomy produces results similar to those of transplantation. For patients with large tumors who are poor candidates for transplantation, resection results in long-term survival in one third of patients.

Figure 1. Survival of patients with HCC according to treatment.

Figure 2. Survival of patients after resection of HCC as related to preoperative AFP levels (ng/ml) (p = 0.002).

Figure 3. Survival of patients after resection of HCC as related to vascular invasion (p = 0.02).

Figure 4. Survival of patients after resection of HCC as related to the presence (solid lines) or absence (dotted lines) of cirrhosis. (A) Results for all patients (p = 0.09); (B) results only for patients with tumors >5 cm (p = 0.03).

Figure 5. Overall survival rates (solid lines) and disease-free survival rates (dotted lines) of patients after resection of HCC as related to size of largest tumor. (A) Data for patients with largest tumors <5 cm; (B) patients with tumors >10 cm.