Survival and Prognostic Factors in Patients with Small Hepatocellular Carcinoma after Curative Resection

Woo, Gwang Hoon; Yoon, Jung Hwan; Han, Chul Ju; Lee, Hyo Suk; Lee, Kun Wook; Kim, Chung Yong

Abstract

BACKGROUND: The survival in patients with hepatocellular carcinoma (HCC) has recently been improved by the advancement in the early detection of HCC. Among the various treatment modalities, the surgical resection has been considered as the most effective for small HCC, and the clinical course of patients with small HCC who underwent curative resection is known to be dependent on the etiology of HCC. Since the differences in the etiology of HCC depend on the different geographical area, it is necessary to verify the clinical outcomes and their affecting factors in patients with small HCC after curative resection in Korea, one of the hepatitis- B-virus(HBU)-endemic areas.
METHODS
A total of 89 patients with small HCC (RESULTS
Serum HBsAg and anti-HCV were positive in 70% and 25% of patients, respectively, and pre-existing liver cirrhosis was found in 73% of patients. Postoperative mortality and morbidity occurred in 2.2% and 21% of patients, respectively. Cumulative recurrence rates at the end of 0.5, 1st, 2nd and 3rd year were 6.3Ya, 15.7%, 35.l% and 52.9%, respectively; cumulative probabilities of progression to hepatic decompensation at the end of 1st, 2nd and 3rd year were 4.2%, 19.4% and 22.6%, respectively; cumulative survival rates at the end of 0.5, 1st, 2nd and 3rd year were 91.1%, 89.9%, 77.9% and 74.5%, respectively. Six patients died as a result of tumor recurrence and eleven patients died of causes not related to tumor recurrence. The most important predictive factor of shorter survival time and higher rate of hepatic decompensation was vascular invasion. Age(>or=50 years old), Child's classification and vascular invasion were factors affecting the rate of recurrence.
CONCLUSION
These results verify that the clinical outcomes of patients with small HCC after curative resection in Korea are similar to those of patients with different etiology of HCC in other geographic areas. To improve the prognosis of patients with small HCC after curative resection, strict preoperative evaluation of the presence of vascular invasion and postoperative preservation of liver function are necessary as well as the close postoperative follow-up for the early detection of recurrence.