Predictors of Survival After Resection of Early Hepatocellular Carcinoma
- 1 May 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 249 (5), 799-805
- https://doi.org/10.1097/sla.0b013e3181a38eb5
Abstract
To identify clinicopathologic factors that predict survival following hepatectomy in patients with early hepatocellular carcinoma (HCC).Although surgical resection of early HCC is thought to be associated with a good outcome, factors predictive of prognosis following resection of these tumors remain ill-defined.The Surveillance, Epidemiology, and End Results database was used to identify patients with histologically confirmed early HCC (< or =5 cm and no nodal involvement, metastases, or major vascular invasion) who underwent surgical resection (not ablation or transplantation) between 1988 and 2005. Prognostic factors were evaluated using Kaplan-Meier curves and Cox proportional hazards models.The study included 788 patients. Median tumor size was 3.2 cm, and 20% of patients had tumors < or =2 cm. Most HCC lesions were solitary (74%) and had no evidence of vascular invasion (82%). Following surgery, overall median and 5-year survival were 45 months and 39%, respectively. After adjusting for demographic factors and histological grade, tumor size >2 cm (hazard ratio [HR]: 1.51), multifocal tumors (HR: 1.51), and vascular invasion (HR: 1.44) remained independent predictors of poor survival (all P < 0.05). Based on these findings, a prognostic scoring system was developed that allotted 1 point each for these factors. Patients with early HCC could be stratified into 3 distinct prognostic groups (median and 5-year survival, respectively): 0 points (70 months, 55%), 1 point (52 months, 42%), and > or =2 points (24 months, 29%) (P < 0.001).Although early HCC is generally associated with a good prognosis, pathologic factors can still be used to stratify patients with respect to survival after resection. These data emphasize the importance of pathologic staging even in small HCC.Keywords
This publication has 29 references indexed in Scilit:
- Diagnosis and Treatment of Hepatocellular CarcinomaGastroenterology, 2008
- Surgical Resection of Hepatocellular CarcinomaThe Cancer Journal, 2008
- Staging of Hepatocellular CarcinomaAnnals of Surgery, 2007
- Racial Differences in Survival of Hepatocellular Carcinoma in the United States: A Population-Based StudyClinical Gastroenterology and Hepatology, 2006
- Management of hepatocellular carcinomaJournal of Hepatology, 2005
- Randomized controlled trial of screening for hepatocellular carcinomaZeitschrift für Krebsforschung und Klinische Onkologie, 2004
- The Continuing Increase in the Incidence of Hepatocellular Carcinoma in the United States: An UpdateAnnals of Internal Medicine, 2003
- Global cancer statistics in the year 2000The Lancet Oncology, 2001
- Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: A retrospective and nationwide survey in JapanJournal of Hepatology, 2000
- Early hepatocellular carcinoma as an entity with a high rate of surgical cureJournal of Hepatology, 1998