Accompanying liver cirrhosis as a risk factor for recurrence after resection of solitary hepatocellular carcinoma.

BACKGROUND/AIMS: A high recurrence rate after hepatic resection adversely influences the postoperative prognosis of patients with hepatocellular carcinoma. In the present study, long-term results and prognostic factors were evaluated in patients who underwent hepatic resection for solitary hepatocellular carcinoma.

METHODOLOGY: The records of 105 patients who underwent hepatic resection for hepatocellular carcinoma between June 1978 and April 2000 were retrospectively reviewed. In 61 patients with solitary hepatocellular carcinoma who survived the curative operation, the prognostic significance of 11 clinicopathological parameters was investigated by univariate and multivariate analyses.

RESULTS: After curative resection, the cumulative survival rate at 5 years in these 61 patients with solitary hepatocellular carcinoma was significantly better than in 25 patients with multiple hepatocellular carcinomas (44% vs. 25%, p = 0.01). However, even in the solitary group, the cumulative recurrence-free survival rate at 5 years was only 32%; and in 27 (75%) of 36 patients, in whom recurrence was confirmed within 5 years, hepatocellular carcinoma recurred within 2 years. Multivariate analysis disclosed that only accompanying liver cirrhosis was a variable having prognostic significance for overall and recurrence-free survival. A study of other clinicopathological factors, including tumor size, failed to demonstrate any prognostic value.

CONCLUSIONS: The present result suggests that hepatic resection can be indicated in patients with solitary hepatocellular carcinoma, irrespective of its size. Though the postoperative recurrence associated with the underlying cirrhosis is still frequent, long-term survival can be expected if the recurrent tumors are successfully treated by a strategy using multiple modalities.