Analysis of the risk factors of untransplantable recurrence after primary curative resection for patients with hepatocellular carcinoma
Journal
Annals of Surgical Oncology
Journal Volume
20
Journal Issue
8
Pages
2526-2533
Date Issued
2013
Abstract
Purpose: To determine the prognostic factors that predict recurrence of hepatocellular carcinoma (HCC) exceeding the University of California at San Francisco (UCSF) criteria after primary resection. Methods: HCC patients who underwent curative liver resections between 2001 and 2007 and who were within the UCSF criteria (n = 716) were examined. Independent prognostic factors were examined by the Cox proportional hazard model. Results: A total of 285 patients (39.8 %) developed recurrences. Of the patients who developed recurrences, 180 had HCC still within the UCSF criteria (63.2 %), and 105 developed HCC beyond this criteria (36.8 %). Among the population with primary transplantable HCC, patients with larger primary tumor sizes, serum α-fetoprotein (AFP) levels over 400 ng/mL, satellite nodules, vascular invasion, or undifferentiated HCC had a risk of untransplantable recurrence, as shown by univariate analysis. In multivariate analysis, undifferentiated HCC and vascular invasion were identified as the significant predictors with adjusted hazard ratios of 9.25 [95 % confidence interval (CI) 2.13-40.21] and 2.19 (95 % CI 1.34-3.58), respectively. When only preoperative factors were considered in multivariate analysis, primary tumor size and serum AFP levels over 400 ng/mL were identified as significant predictors with adjusted hazard ratios of 1.24 (95 % CI 1.07-1.45) and 1.72 (95 % CI 1.05-2.82), respectively. Conclusions: For primary HCC patients within the UCSF criteria, larger tumor sizes and AFP levels over 400 ng/mL were associated with postresection recurrence of HCC exceeding the UCSF criteria. Because these are clearly markers for aggressive tumor biology, whether early primary transplant will alter the aggressive tumor behaviors warrant further investigation. ? 2013 Society of Surgical Oncology.
SDGs
Other Subjects
fetoprotein; tumor marker; adult; aged; article; biology; blood level; cancer recurrence; cancer size; cancer surgery; female; human; liver cell carcinoma; lymph vessel metastasis; major clinical study; male; neoplasm; preoperative period; primary tumor; risk factor; tumor invasion; Aged; alpha-Fetoproteins; Blood Vessels; Carcinoma, Hepatocellular; Disease-Free Survival; Female; Hepatectomy; Humans; Liver Neoplasms; Liver Transplantation; Male; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Patient Selection; Risk Factors; Tumor Burden
Type
journal article