Ann Hepatobiliary Pancreat Surg.  2020 Nov;24(4):431-436. 10.14701/ahbps.2020.24.4.431.

Prognosis after intrahepatic recurrence in the patients who underwent curative resection for hepatocellular carcinoma

• Lee J
• Cho EH
• Kim SB
• Kim R

• KMID: 2508851
• DOI: http://doi.org/10.14701/ahbps.2020.24.4.431

Abstract

Backgrounds/Aims
Intrahepatic recurrence is frequent result after hepatectomy for hepatocellular carcinoma (HCC). We analyzed the clinical results of patients who had the intrahepatic recurrences of HCC after curative surgical resections.
Methods
From January 2009 to December 2016, 320 patients underwent curative surgical resection for HCC in department of Surgery, Korea Cancer Center Hospital. After surgical resection, 155 patients had suffered HCC recurrence during follow-up period. Among them, 122 patients had only intrahepatic recurrence initially, who were included in this retrospective study. We analyzed about the period of the recurrence after surgery, treatment methods for the recurred tumors, and poor prognostic factors for survival after intrahepatic recurrences.
Results
Among the 122 patients, 83 patients had recurrence within 24 months after surgery. Thirty-eight patients underwent curative treatment for the recurred tumors (re-resection in 18, radiofrequency ablation in 20 patients). Non-curative treatments were performed in 77 patients (TACE in 68 patients, radiotherapy in 9 patients) and conservative management in 7 patients. Five-year survival rate of patients who underwent curative treatment is 86.4% (p≤0.001). Five-year survival rate of non-curative treatment is 55.7% (p≤0.001), conservative management is 0% (p=0.021). Among the clinical factors, non-curative treatment for recurred tumor, AFP level at the time of recurrence, size of recurred tumor were independent poor prognostic factors for survival after intrahepatic recurrences (p<0.001).
Conclusions
For the patients who had intrahepatic recurrent HCC after surgery, aggressive local treatment can improve the prognosis in selective cases. Further study is necessary to validate this retrospective investigation.

Keyword

Hepatocellular carcinoma; Intrahepatic recurrence; Survival

Figure

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  Fig. 1 Five-year overall survival rate of 122 patients after initial IHR is 62%, and 10-year overall survival is 55.1%.

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  Fig. 2 The 5-year survival rate was 90.3% for patients of late recurrence group and 52.8% for patients of early recurrence group. The survival rate was higher when the time between the surgery and the recurrence was longer (p=0.015).

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  Fig. 3 Survival rate of patients who had curative treatment was 86.4%. Survival rate of patients who had non-curative treatment was 55.7%, conservative management was 0% (p=0.05).

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  Fig. 4 Prognosis is better when performing curative treatment in early recurrence group. (A) The survival rate according to the method of treatment was significantly different in early recurrence group (p<0.05). (B) There was no difference in late recurrence group in late recurrence group.

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