J Korean Surg Soc.  2009 Feb;76(2):94-99. 10.4174/jkss.2009.76.2.94.

Prognostic Factors and Clinicopathologic Features after Resection of Small Hepatocellular Carcinoma (< or =2 cm)

• Kang SY
• Kim HJ
• Yoon SS
• Lee DS

• KMID: 2211263
• DOI: http://doi.org/10.4174/jkss.2009.76.2.94

Abstract

PURPOSE
Hepatectomy has been regarded as the first treatment of choice for small hepatocellular carcinoma. However, hepatectomy for treatment of small hepatocellular carcinoma remains a critical issue. This study evaluates the role of treatment regarding the survival rate and clinicopathological features after resection of small hepatocellular carcinoma ((< or =2 cm)
METHODS
This retrospective study was based on the medical records of 48 small hepatocellular carcinoma (< or =2 cm) patients who received surgical hepatectomy from 1990 to 2005. Patients who revealed on postoperative pathologic reports were enrolled. The survival rate was analyzed according to clinicopathologic and therapeutic factors and we analyzed the pathologic features of the recurrence group.
RESULTS
The presence of liver cirrhosis, ICGR15 (Indocyanine green retension-15) was statistically significant in the univariate analysis. The vascular invasion rate and capsule formation rate was 90, 80% in the recurrence group.
CONCLUSION
In the small hepatocellular carcinoma ((< or =2 cm), the presence of liver cirrhosis, ICGR15 (Indocyanine green retension-15) should be checked to predict prognosis. The small hepatocellular carcinoma ((< or =2 cm) is similar to advanced hepatocellular carcinoma so hepatectomy may play an important role in the small hepatocellular carcinoma ((< or =2 cm).

Keyword

Small hepatocellular carcinoma ((< or =2 cm); Prognostic factors; Clinicopathologic factors

MeSH Terms

Carcinoma, Hepatocellular
Hepatectomy
Humans
Liver Cirrhosis
Medical Records
Prognosis
Recurrence
Retrospective Studies
Survival Rate

Figure

• 

  Fig. 1 Survival curves of 48 patients with small hepatocellular carcinoma.

• 

  Fig. 2 Disease-free survival curves of 48 patients with small hepatocellular carcinoma.

• 

  Fig. 3 Survival curves after resection with and without liver cirrhosis.

• 

  Fig. 4 Survival curves after resection between above 10 of R15 and below 10 of R15.

• 

  Fig. 5 Survival curves of 48 patients with small hepatocellular carcinoma after resection.

Reference

1. Muto Y, Moriwaki H, Ninomiya M, Adachi S, Saito A, Takasaki KT, et al. Hepatoma Prevention Study Group. Prevention of second primary tumors by an acyclic retinoid, polyprenoic acid, in patients with hepatocellular carcinoma. N Engl J Med. 1996. 334:1561–1567.

2. Wang ZL, Liang P, Dong BW, Yu XL, Yu de J. Prognostic factors and recurrence of small hepatocellular carcinoma after hepatic resection or microwave ablation: a retrospective study. J Gastrointest Surg. 2008. 12:327–337.

3. Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg. 1999. 229:216–222.

4. Kumada T, Nakano S, Takeda I, Sugiyama K, Osada T, Kiriyama S, et al. Treatment of small hepatocellular carcinoma. Cancer Chemother Pharmacol. 1992. 31:Suppl. S25–S29.

5. Nagashima I, Hamada C, Naruse K, Osada T, Nagao T, Kawano N, et al. Surgical resection for small hepatocellular carcinoma. Surgery. 1996. 119:40–45.

6. Nagao T, Nagashima I, Inoue S, Omori Y, Kawano N, Morioka Y. Hepatic resection for minute hepatocellular carcinoma. Surg Today. 1992. 22:110–114.

7. Liver Cancer Study Group of Japan. The General Rules for the Clinical and Pathological Study of Primary Liver Cancer. 1992. 3rd ed. Tokyo: Kanehara Shuppan.

8. Arii S, Yamaoka Y, Futagawa S, Inoue K, Kobayashi K, Kojiro M, et al. The Liver Cancer Study Group of Japan. Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. Hepatology. 2000. 32:1224–1229.

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

10. Yamasaki S, Hasegawa H, Makuuchi M, Takayama T, Kosuge T, Shimada K. Choice of treatments for small hepatocellular carcinoma: hepatectomy, embolization or ethanol injection. J Gastroenterol Hepatol. 1991. 6:408–413.

11. Yokoi H, Kawarada Y. Current status of treatment for small hepatocellular carcinoma. Gan To Kagaku Ryoho. 1996. 23:855–861.

12. Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg. 1999. 229:790–799.

13. Nagasue N. Liver resection for hepatocellular carcinoma: indications, techniques, complications, and prognostic factors. J Hepatobiliary Pancreat Surg. 1998. 5:7–13.

14. Franco D, Usatoff V. Resection of hepatocellular carcinoma. Hepatogastroenterology. 2001. 48:33–36.

15. Chen JY, Chau GY, Lui WY, Tsay SH, King KL, Wu CW. Clinicopathologic features and factors related to survival of patients with small hepatocellular carcinoma after hepatic resection. World J Surg. 2003. 27:294–298.

16. Sasaki Y, Imaoka S, Ishiguro S, Nakano H, Kasugai H, Fujita M, et al. Clinical features of small hepatocellular carcinomas as assessed by histologic grades. Surgery. 1996. 119:252–260.

17. Tung-Ping Poon R, Fan ST, Wong J. Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg. 2000. 232:10–24.

18. Kanai T, Hirohashi S, Upton MP, Noguchi M, Kishi K, Makuuchi M, et al. Pathology of small hepatocellular carcinoma. A proposal for a new gross classification. Cancer. 1987. 60:810–819.

19. Okamura J, Monden M, Sakon M, Mori T, Kuroda C, Sakurai M. Pathogenesis and selection of treatment modalities for hepatocellular carcinoma. Gan To Kagaku Ryoho. 1986. 13:203–209.

20. Sasaki Y, Imaoka S, Nakano H, Ishikawa O, Ohigashi H, Yasuda T, et al. Indications for hepatectomy for hepatocellular carcinoma - what stage of the disease is the best indication for surgery? J Hepatobiliary Pancreat Surg. 1998. 5:14–17.

21. Makuuchi M, Takayama T, Kubota K, Kimura W, Midorikawa Y, Miyagawa S, et al. Hepatic resection for hepatocellular carcinoma -- Japanese experience. Hepatogastroenterology. 1998. 45:Suppl 3. 1267–1274.

22. Shirabe K, Kanematsu T, Matsumata T, Adachi E, Akazawa K, Sugimachi K. Factors linked to early recurrence of small hepatocellular carcinoma after hepatectomy: univariate and multivariate analyses. Hepatology. 1991. 14:802–805.

23. Nakajima Y, Nagabuchi E, Sato N, Kamiyama T, Matsuoka S, Une Y, et al. A clinical study of liver resections in patients with small hepatocellular carcinoma less than three centimeter in diameter. Nippon Geka Gakkai Zasshi. 1992. 93:1087–1090.

24. Nakajima Y, Shimamura T, Kamiyama T, Kimura J, Sato N, Matsushita M, et al. Evaluation of surgical resection for small hepatocellular carcinomas. Am J Surg. 1996. 171:360–363.

25. Ezaki T, Koyanagi N, Yamagata M, Kajiyama K, Maeda T, Sugimachi K. Postoperative recurrence of solitary small hepatocellular carcinoma. J Surg Oncol. 1996. 62:115–122.

26. Hanazaki K, Kajikawa S, Shimozawa N, Mihara M, Shimada K, Hiraguri M, et al. Survival and recurrence after hepatic resection of 386 consecutive patients with hepatocellular carcinoma. J Am Coll Surg. 2000. 191:381–388.