Yonsei Med J.  2006 Feb;47(1):105-112. 10.3349/ymj.2006.47.1.105.

The Actual Five-year Survival Rate of Hepatocellular Carcinoma Patients after Curative Resection

• Lee JG
• Kang CM
• Park JS
• Kim KS
• Yoon DS
• Choi JS
• Lee WJ
• Kim BR

• KMID: 1715879
• DOI: http://doi.org/10.3349/ymj.2006.47.1.105

Abstract

The five-year survival rate of patients after curative resection of hepatocellular carcinoma (HCC) has been reported to be 30 to 50 %, however the actual survival rate may be different. We analyzed the actual 5-year survival rate and prognostic factors after curative resection of HCC. Retrospective analysis was performed on 63 HCC patients who underwent curative resection from 1998 to 1999. A total of 63 cases were reviewed, consisting of 53 men and 10 women, with a median age of 49 years. These cases included all four pathologic T stages (pT stage) and had the following representation: stage 1 (1 case), stage 2 (17 cases), stage 3 (38 cases), and stage 4 (7 cases). In our study, the actual 5-year survival rate was 57.0% and the median survival time was 60 months. In addition, the patients in our study had an actual 5-year disease-free survival rate of 50.2% and a median disease-free survival time of 46 months. Thirty-one patients had recurrences, with a majority occurring within one year (65%). These patients with early recurrences had a poor actual 5-year survival rate of 5%. A univariate analysis showed that the prognostic factors influencing survival rate were the presence of satellite nodules, increased pT stage, HCC recurrence, and the time to recurrence (within one year). Interestingly, microvascular invasion made a difference in survival rate but was not statistically significant (p = 0.08). Furthermore, factors influencing the disease free survival rate include the presence of satellite nodules, microvascular invasion, and pT stage. Multivariate analysis identified pT stage as the only statistically related factor in determining the disease-free survival rate. The most important prognostic factor of HCC is recurrence. Moreover, the major risk factor for recurrence is an advanced pT stage. Therefore, performing prospective studies of postoperative adjuvant therapy is necessary to prevent recurrences after hepatic resection. Furthermore, active preventative treatment and early diagnosis of recurrences should be of the highest priority in the care of high-risk patient groups that have an advanced pT stage.

Keyword

Hepatocellular carcinoma; hepatic resection; five-year survival rate

MeSH Terms

Survival Rate
Retrospective Studies
Middle Aged
Male
Liver Neoplasms/*mortality/pathology/*surgery
Liver/pathology/surgery
Humans
*Hepatectomy
Female
Carcinoma, Hepatocellular/*mortality/pathology/*surgery
Aged
Adult

Figure

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  Fig. 1 The actual survival rate compared to the disease-free survival rate.

Reference

1. Lai EC, Fan ST, Lo CM, Chu KM, Liu CL, Wong J. Hepatic resection for hepatocellular carcinoma. An audit of 343 patients. Ann Surg. 1995. 221:291–298.

2. Cance WG, Stewart AK, Menck HR. The national cancer database report on treatment patterns for hepatocellular carcinoma: improved survival of surgically resected patients, 1985-1996. Cancer. 2000. 88:912–920.

3. Takano S, Oishi H, Kono S, Kawakami S, Nakamura M, Kubota N, et al. Retrospective analysis of type of hepatic resection for hepatocellular carcinoma. Br J Surg. 2000. 87:65–70.

4. Bae TS, Kim SB, Park SH, Choi DW. Outcome of hepatic resection for hepatocellular carcinoma patients. J Korean Surg Soc. 2003. 64:480–486.

5. Choi YM, Kang KC, Ahn SI, Lee KY, Hong KC, Choi SK, et al. Clinical analysis of prognostic factors in hepatocellular carcinoma. J Korean Surg Soc. 2003. 65:42–48.

6. Park CK, Jang WY, Lee JI, Song SY, Choi MS, Cho JW, et al. Prognostic factors after hepatic resection of hepatocellular carcinoma: Univariate and multivariate analysis. Korean J Gastroenterol. 2002. 39:33–39.

7. Song TJ, IP EW, Fong Y. Hepatocellular carcinoma: Current surgical management. Gastroenterology. 2004. 127:248–260.

8. Yu AS, Keeffe EB. Management of hepatocellular carcinoma. Rev Gastroenterol Disord. 2003. 3:8–24.

9. Marin-Hargreaves G, Azoulay D, Bismuth H. Hepatocellular carcinoma: surgical indications and results. Crit Rev Oncol Hematol. 2003. 47:13–27.

10. Yeh CN, Lee WC, Chen MF, Tsay PK. Predictors of long-term disease-free survival after resection of hepatocellular carcinoma: two decades of experience at Chang Gung Memorial Hospital. Ann Surg Oncol. 2003. 10:916–921.

11. Ikai I, Arii S, Kojiro M, Ichida T, Makuuchi M, Matsuyama Y, et al. Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Cancer. 2004. 101:796–802.

12. Hwang IS, Hong SW, Nah YW, Jang YG, Kim KH, Lee HS. Analysis of 38 long-term survivors after liver resections for hepatocellular carcinomas. Korean J HBP Surg. 2000. 4:67–76.

13. Chang CH, Chau GY, Lui WY, Tsay SH, King KL, Wu CW. Long-term results of hepatic resection for hepatocellular carcinoma originating from the noncirrhotic liver. Arch Surg. 2004. 139:320–325.

14. Shimozawa N, Hanazaki K. Longterm prognosis after hepatic resection for small hepatocellular carcinoma. J Am Coll Surg. 2004. 198:356–365.

15. Ramacciato G, Mercantinie P, Cautero N, Corigliano N, di Benedetto F, Quintini C, et al. Prognostic evaluation of the new American joint committee on cancer/international union against cancer staging system for hepatocellular carcinoma: analysis of 112 cirrhotic patients resected for hepatocellular carcinoma. Ann Surg Oncol. 2005. 14:Epub ahead of print.

16. Qin LX, Tang ZY. The prognostic significance of clinical and pathological features in hepatocellular carcinoma. World J Gastroenterol. 2002. 8:193–199.

17. Lau H, Fan ST, Ng IOL, Wong J. Long term prognosis after hepatectomy for hepatocellular carcinoma: A survival analysis of 204 consecutive patients. Cancer. 1998. 83:2302–2311.

18. Kim GS, Roh JH, Cho CK, Kim HJ. Long-term survival rates and prognostic factors for a hepatocellular carcinoma after a curative hepatic resection. J Korean Surg Soc. 1999. 57:715–727.

19. Han SH, Lee WJ, Noh SH, Kim MW, Kim BR, Lee KS. Univariate and multivariate analysis of prognostic factors in survival after resection of primary hepatoma. J Korean Surg Soc. 1994. 47:393–400.

20. Park JW. Practice guideline for diagnosis and treatment of hepatocellular carcinoma. Korean J Hepatol. 2004. 10:88–98.

21. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001. 35:421–430.