Effectiveness of Diagnogstic Tools for The Detection of Recurrence after Curative Resection of Hepatocellular Carcinoma

Cho, Yong Beom; Suh, Kyung Suk; Koh, Young Taeg; Roh, Helen; Kim, Sun Whe; Kim, Sang Joon; Lee, Kuhn Uk; Park, Yong Hyun

Abstract

BACKGROUND/AIMS: In spite of improved diagnostic and therapeutic methods, the prognosis of hepatocarcinoma( HCC) is still poor because of the high recurrence rate. Early detection and active treatment of recurrent HCC are important to improve the survival. The objective of this study is to compare the effectiveness of diagnostic tools for early detection of the recurrence of HCC.
METHODS
We retrospectively studied 236 patients who underwent curative hepatic resection for HCC at SNUH between 1993 and 1995. Postoperatively, we checked radiologic studies every three months and serum alpha- fetoprotein level monthly first, then every three months to detect recurrence. The patients were divided into four group (Low-Low;L-L, Low-High;L-H, High-Low;H-L, High-High;H-H) according to the serum levels of pre- and post-operative(3 months) alpha-fetoprotein levels (Low ; <20ng/ml, High >20ng/ml).
RESULTS
Overall recurrence rate was 55.1%. The recurrence rates in L-L gr., L-H gr, H-L gr., and H-H gr were 40.7%, 75.0%, 42.9% and 91.8% respectively. Increasing levels of alpha-fetoprotein at the time of dectection of recurrence were found in 13.6%, 66.7%, 25.9% and 92.9%, respectively(p<0.05). The 3- year disease-free survival rates are 62.1%, 25.0%, 57.8% and 6.3%, respectively(p<0.05). The 3-year overall survival rates are 79.2%, 50.0%, 83.6% and 51.1%, respectively(p<0.05). The detection rates of ultrasonography(US) and computed tomograpy(CT) were 82.4% and 97.2% respectively. Seven patients had lung metastasis on chest X-ray and two bone metastasis on bone scan, two spinal metastasis on spine X-ray and MRI and 2 adrenal metastasis by US and CT were detected.
CONCLUSION
The patients who have high serum levels of alpha-fetoprotein postoperatively have a tendency to recur early. On the other hand, patients who have low serum levels of alpha-fetoprotein postoperatively recur late, usually without its elevation. Therefore, in former cases, early recurrence or remnant tumor should be suspected and in latter cases, regular US and/or CT is a more useful method for early detection of recurrent HCC than frequent checking of serum alpha-fetoprotein.