Portal de Periódicos da CAPES

Factors associated with recurrence and survival following hepatectomy for large hepatocellular carcinoma: A multicenter analysis

2009; Wiley; Volume: 101; Issue: 2 Linguagem: Inglês

10.1002/jso.21461

1096-9098

Suzanne Schiffman, Charles E. Woodall, David A. Kooby, Robert C.G. Martin, Charles A. Staley, Vasili Egnatashvili, Kelly M. McMasters, Charles R. Scoggins,

Cholangiocarcinoma and Gallbladder Cancer Studies

Abstract Background Optimal management of large (>5 cm) hepatocellular carcinoma (HCC) remains controversial. We sought to determine the factors associated with recurrence and survival for patients with large HCC following hepatectomy. Methods An analysis of a combined prospective database from two tertiary care centers was performed on consecutive patients who underwent hepatectomy for HCC > 5 cm. Univariate and multivariate analyses were performed to determine factors associated with recurrence, disease‐free (DFS) and overall survival (OS). Results Seventy‐eight patients were identified: 32 (41%) had hepatic fibrosis. Forty‐six patients (59%) underwent a major hepatectomy with a morbidity rate of 41% and a mortality rate of 13%. Fibrosis was associated with male gender ( P = 0.045), hepatitis C ( P = 0.003), higher Child‐Pugh ( P < 0.0001) and Okuda score ( P = 0.002), smaller tumors (6.25 cm vs. 10.5 cm; P < 0.001), positive‐margin resection ( P = 0.01), and death ( P = 0.047). Factors associated with recurrence include tumor multifocality ( P = 0.03) and vascular invasion ( P = 0.02). Predictors of OS include multifocal tumors ( P = 0.05), margin status ( P = 0.02), vascular invasion ( P = 0.01), and treatment complications ( P = 0.004). The median overall DFS and OS were 12 and 20 months, respectively. Fibrosis had no impact on DFS ( P = 0.24) or OS ( P = 0.20). Conclusions For patients with HCC larger than 5 cm, tumor‐related factors predict outcomes and survival. J. Surg. Oncol. 2010;101:105–110. © 2009 Wiley‐Liss, Inc.