S. G. Barreto MS, PhD; M. Brooke-Smith FRACS, PhD; P. Dolan FRACS; T. G. Wilson FRACS; R. T. A. Padbury FRACS, PhD; J. W. C. Chen FRACS, PhD.
Cirrhosis and microvascular invasion predict outcomes in hepatocellular carcinoma
Version of Record online: 3 SEP 2012
© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 83, Issue 5, pages 331–335, May 2013
How to Cite
Barreto, S. G., Brooke-Smith, M., Dolan, P., Wilson, T. G., Padbury, R. T. A. and Chen, J. W. C. (2013), Cirrhosis and microvascular invasion predict outcomes in hepatocellular carcinoma. ANZ Journal of Surgery, 83: 331–335. doi: 10.1111/j.1445-2197.2012.06196.x
- Issue online: 24 APR 2013
- Version of Record online: 3 SEP 2012
- Manuscript Accepted: 5 JAN 2012
- Child-Pugh criteria;
Liver resection (LR) and liver transplantation (LT) are two modalities offering potential for cure in patients with hepatocellular carcinoma (HCC). The objective of this study was to evaluate the long-term survival of patients with HCC treated with LT and LR and to analyse variables influencing these outcomes.
Patients referred to the South Australian Liver Transplant Unit and Hepatopancreatobiliary Unit at Flinders Medical Centre from January 1992 to September 2009 with a diagnosis of HCC who underwent LT or LR were included in the study. Histopathological parameters analysed included size, number and grade of tumour, microscopic vascular invasion and presence or absence of cirrhosis in remnant liver.
Eighty-five patients with a median age of 58 years (range 26–85 years) underwent LT or LR. Median follow-up was 40 months in both groups. Overall, 5-year actuarial survival for all patients with HCC in both groups was 55%. LR patients were significantly older (P < 0.001) than LT patients. Their tumours were larger (P < 001) and more often solitary (P < 0.001) compared with the LT group. In multivariate analysis, age >60 (P < 0.02), histopathological evidence of vascular invasion (P < 0.02) and presence of cirrhosis (P < 0.02) were associated with a significantly reduced survival. Patients without vascular invasion and cirrhosis had an actuarial 5-year survival >70%.
Our study indicates that LT (within University of California, San Francisco criteria) and LR can lead to acceptable long-term survival outcomes in patients with HCC. Microscopic vascular invasion and cirrhosis were the most significant prognostic factors impacting on survival.