Hepatectomy survival rates high in patients with solitary tumors
MedWire News: Study findings suggest that partial hepatectomy 5-year survival rates are highest among hepatocellular carcinoma (HCC) patients with a tumor status within the Milan criteria who have underlying chronic hepatitis or a solitary tumor of 5 cm or less in size.
In addition, the study showed that patients with normal liver function did not have better overall survival than those with cirrhosis, while the worst survival was seen in patients with oligonodular tumors.
"The data indicate that a significant portion of patients with HCC eligible for liver transplantation can be treated effectively by hepatectomy," say Sheung Fan (University of Hong Kong, China) and co-authors.
The researchers performed a retrospective analysis on 408 HCC patients with a tumor status within the Milan criteria who underwent partial hepatectomy at a single center during 1995-2008. Outcomes were compared with those of adult patients with similar tumor status undergoing right-lobe living donor liver transplantation (LDLT) as a primary treatment.
All patients were followed-up on a monthly basis in the first year and quarterly thereafter. Recurrence was diagnosed by computed tomography or magnetic resonance imaging, supplemented by tumor biopsy where necessary.
In total, 30.4% and 69.6% of patients were treated by major and minor hepatectomy, respectively, with in-hospital mortality rates of 5.6% and 1.4%, respectively.
In all, 384 patients had a solitary tumor of 5 cm or less in diameter, and 24 had oligonodular tumors (two to three nodules, each of 3 cm or less). After a median follow-up of 55.5 months, recurrence was detected in 49.9% of patients with a solitary tumor and in 73.0% of patients with an oligonodular tumor.
The majority of recurrences (76.8%) occurred in the first 3 years after partial hepatectomy, with 1-, 3-, and 5-year survival rates of 92.6%, 80.9%, and 69.1%, respectively. Corresponding disease-free survival rates were 77.3%, 57.4%, and 48.7%.
Compared with patients with oligonodular tumors, those with a solitary tumor had significantly better overall survival (median 111.3 vs 42.9 months) and disease-free survival (median 62.8 vs 12.2 months).
The 1-, 3-, and 5- year overall survival rates were 93.2%, 81.9%, and 70.7%, respectively, in patients with a solitary tumor, compared with 83.0%, 66.0%, and 46.0%, respectively, in patients with oligonodular tumors.
The corresponding disease-free survival rates were 78.6%, 58.6% and 50.5% in patients with a solitary tumor, and 55.0%, 36.0%, and 21.0% in those with olignodular tumors.
Significant predictors of favorable overall survival identified by multivariate analysis included younger age (≤65 years; odds ratio [OR]=0.64), lack of postoperative complications (OR=0.60), negative resection margin (OR=0.29), absent microvascular invasion (OR=0.36), and non-cirrhotic liver (OR=0.55).
For disease-free survival, favorable factors included younger age (OR=0.64), absence of microvascular invasion (OR=0.54), non-cirrhotic liver (OR=0.54), and solitary tumor (OR=0.52).
Furthermore, the 5-year survival rate of 287 younger patients with chronic liver disease and R0 hepatectomy was not significantly different from that seen in 50 similar patients treated by LDLT, at 72.8% versus 81.0%.
In an associated commentary, Ulf Neumann (University Hospital Aachen, Germany) said: "These data change the perspective on the indication for hepatic resection patients with HCC."
The findings are published in the British Journal of Surgery.
By Ingrid Grasmo