Long-term results of resection for large hepatocellular carcinoma: A multivariate analysis of clinicopathological features



Recurrent or metastatic disease is frequently en-countered among patients who have had resection of their primary hepatocellular carcinoma. A retro-spective study on 117 patients (104 men, 13 women; mean age ± standard deviation: 53.8 ± 12.4 yr) who had hepatectomy for large hepatocellular carcinoma (diameter ≧ 5 cm) was conducted to identify an at-risk population for tumor recurrence. Disease-free survival was correlated with 22 clinical (n = 5), serological (n = 2), gross pathological (n = 3) and histological (n = 12) features of the resected specimens using Cox's multivariate regression analysis. Recurrent hepatocel-lular carcinoma was detected in 74 patients within a median follow-up period of 13.7 mo. Although 17 patients had extrahepatic disease alone, recurrence was confined to the hepatic remnant in 40 patients. Disease-free survival rates at 1, 3 and 5 yr were 40%, 19% and 12%, respectively. Two of the five histological parameters isolated, negative resection margin (p <0.01) and encapsulation (p < 0.006), were identified as favorable independent prognostic predictors. When patients with positive margins were excluded from the analysis, repeated calculation showed that encapsu-lation was the only important determinant. From this analysis, detailed histological study of the resected tumor is seen to be the only satisfactory means for assessing long-term prognosis. An aggressive approach is warranted among patients with encapsulated tu-mors. Even with a clear resection margin, adjuvant treatment should be considered for those patients who have unencapsulated lesions.(HEPATOLOGY 1990; 11:815-818.)