Hepatic resection can provide long-term survival of patients with non-early-stage hepatocellular carcinoma: Extending the Indication for resection?

Wen Tsan Chang, Wei Yu Kao, Gar Yang Chau, Chien Wei Su, Hao Jan Lei, Jaw Ching Wu, Cheng Yuan Hsia, Wing Yiu Lui, Kuang Liang King, Shou Dong Lee

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Abstract

Background: Indications for resection of non-early-stage hepatocellular carcinoma (HCC) remain controversial. This study aimed to identify factors that affect outcome of patients with Barcelona Clinical Liver Cancer Classification (BCLC) stage B or stage C HCC after hepatic resection. Methods: From 1991 to 2006, 478 patients with HCC (BCLC stage B, n = 318 and BCLC stage C, n = 160) who underwent resection were enrolled. Factors in terms of overall survival and recurrence were analyzed. Results: After a median follow-up of 29.5 months, 304 patients had died. The cumulative overall survival rate at 5 years was 46.5% in BCLC stage B patients and 29.1% in stage C patients (P <.001). Multivariate analysis disclosed that serum albumin levels ≤4 g/dL, indocyanine green retention rate at 15 minutes >10%, serum creatinine >1.2 mg/dL, multinodularity, Edmondson stage III or IV in tumor cell differentiation, and the presence of macroscopic vascular invasion were independent risk factors of poor overall survival. There were 331 patients with tumor recurrence after resection. Recurrence rate was less in BCLC stage B than that in BCLC stage C (P =.001). Multivariate analysis showed that serum albumin level ≤4 g/dL, multinodularity, cut margin ≤1 cm, and Edmondson stage III or IV were associated with the recurrence of HCC. Conclusion: Hepatic resection can provide long-term survival benefit in selected BCLC stage B or C patients with compensated liver function, especially in those presenting with a single neoplasm without vascular invasion.

Original languageEnglish
Pages (from-to)809-820
Number of pages12
JournalSurgery (United States)
Volume152
Issue number5
DOIs
Publication statusPublished - Nov 1 2012
Externally publishedYes

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Liver Neoplasms
Hepatocellular Carcinoma
Survival
Liver
Recurrence
Vascular Neoplasms
Serum Albumin
Blood Vessels
Cell Differentiation
Creatinine
Neoplasms
Multivariate Analysis
Survival Rate
Serum

ASJC Scopus subject areas

  • Surgery

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Hepatic resection can provide long-term survival of patients with non-early-stage hepatocellular carcinoma : Extending the Indication for resection? / Chang, Wen Tsan; Kao, Wei Yu; Chau, Gar Yang; Su, Chien Wei; Lei, Hao Jan; Wu, Jaw Ching; Hsia, Cheng Yuan; Lui, Wing Yiu; King, Kuang Liang; Lee, Shou Dong.

In: Surgery (United States), Vol. 152, No. 5, 01.11.2012, p. 809-820.

Research output: Contribution to journalArticle

Chang, Wen Tsan ; Kao, Wei Yu ; Chau, Gar Yang ; Su, Chien Wei ; Lei, Hao Jan ; Wu, Jaw Ching ; Hsia, Cheng Yuan ; Lui, Wing Yiu ; King, Kuang Liang ; Lee, Shou Dong. / Hepatic resection can provide long-term survival of patients with non-early-stage hepatocellular carcinoma : Extending the Indication for resection?. In: Surgery (United States). 2012 ; Vol. 152, No. 5. pp. 809-820.
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abstract = "Background: Indications for resection of non-early-stage hepatocellular carcinoma (HCC) remain controversial. This study aimed to identify factors that affect outcome of patients with Barcelona Clinical Liver Cancer Classification (BCLC) stage B or stage C HCC after hepatic resection. Methods: From 1991 to 2006, 478 patients with HCC (BCLC stage B, n = 318 and BCLC stage C, n = 160) who underwent resection were enrolled. Factors in terms of overall survival and recurrence were analyzed. Results: After a median follow-up of 29.5 months, 304 patients had died. The cumulative overall survival rate at 5 years was 46.5{\%} in BCLC stage B patients and 29.1{\%} in stage C patients (P <.001). Multivariate analysis disclosed that serum albumin levels ≤4 g/dL, indocyanine green retention rate at 15 minutes >10{\%}, serum creatinine >1.2 mg/dL, multinodularity, Edmondson stage III or IV in tumor cell differentiation, and the presence of macroscopic vascular invasion were independent risk factors of poor overall survival. There were 331 patients with tumor recurrence after resection. Recurrence rate was less in BCLC stage B than that in BCLC stage C (P =.001). Multivariate analysis showed that serum albumin level ≤4 g/dL, multinodularity, cut margin ≤1 cm, and Edmondson stage III or IV were associated with the recurrence of HCC. Conclusion: Hepatic resection can provide long-term survival benefit in selected BCLC stage B or C patients with compensated liver function, especially in those presenting with a single neoplasm without vascular invasion.",
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T1 - Hepatic resection can provide long-term survival of patients with non-early-stage hepatocellular carcinoma

T2 - Extending the Indication for resection?

AU - Chang, Wen Tsan

AU - Kao, Wei Yu

AU - Chau, Gar Yang

AU - Su, Chien Wei

AU - Lei, Hao Jan

AU - Wu, Jaw Ching

AU - Hsia, Cheng Yuan

AU - Lui, Wing Yiu

AU - King, Kuang Liang

AU - Lee, Shou Dong

PY - 2012/11/1

Y1 - 2012/11/1

N2 - Background: Indications for resection of non-early-stage hepatocellular carcinoma (HCC) remain controversial. This study aimed to identify factors that affect outcome of patients with Barcelona Clinical Liver Cancer Classification (BCLC) stage B or stage C HCC after hepatic resection. Methods: From 1991 to 2006, 478 patients with HCC (BCLC stage B, n = 318 and BCLC stage C, n = 160) who underwent resection were enrolled. Factors in terms of overall survival and recurrence were analyzed. Results: After a median follow-up of 29.5 months, 304 patients had died. The cumulative overall survival rate at 5 years was 46.5% in BCLC stage B patients and 29.1% in stage C patients (P <.001). Multivariate analysis disclosed that serum albumin levels ≤4 g/dL, indocyanine green retention rate at 15 minutes >10%, serum creatinine >1.2 mg/dL, multinodularity, Edmondson stage III or IV in tumor cell differentiation, and the presence of macroscopic vascular invasion were independent risk factors of poor overall survival. There were 331 patients with tumor recurrence after resection. Recurrence rate was less in BCLC stage B than that in BCLC stage C (P =.001). Multivariate analysis showed that serum albumin level ≤4 g/dL, multinodularity, cut margin ≤1 cm, and Edmondson stage III or IV were associated with the recurrence of HCC. Conclusion: Hepatic resection can provide long-term survival benefit in selected BCLC stage B or C patients with compensated liver function, especially in those presenting with a single neoplasm without vascular invasion.

AB - Background: Indications for resection of non-early-stage hepatocellular carcinoma (HCC) remain controversial. This study aimed to identify factors that affect outcome of patients with Barcelona Clinical Liver Cancer Classification (BCLC) stage B or stage C HCC after hepatic resection. Methods: From 1991 to 2006, 478 patients with HCC (BCLC stage B, n = 318 and BCLC stage C, n = 160) who underwent resection were enrolled. Factors in terms of overall survival and recurrence were analyzed. Results: After a median follow-up of 29.5 months, 304 patients had died. The cumulative overall survival rate at 5 years was 46.5% in BCLC stage B patients and 29.1% in stage C patients (P <.001). Multivariate analysis disclosed that serum albumin levels ≤4 g/dL, indocyanine green retention rate at 15 minutes >10%, serum creatinine >1.2 mg/dL, multinodularity, Edmondson stage III or IV in tumor cell differentiation, and the presence of macroscopic vascular invasion were independent risk factors of poor overall survival. There were 331 patients with tumor recurrence after resection. Recurrence rate was less in BCLC stage B than that in BCLC stage C (P =.001). Multivariate analysis showed that serum albumin level ≤4 g/dL, multinodularity, cut margin ≤1 cm, and Edmondson stage III or IV were associated with the recurrence of HCC. Conclusion: Hepatic resection can provide long-term survival benefit in selected BCLC stage B or C patients with compensated liver function, especially in those presenting with a single neoplasm without vascular invasion.

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