[Prognostic factors influencing postoperative survival in patients with
Fu-sheng Wu, Wen-he Zhao, Ting-bo Liang, Guo-ping Ren, Zhi-min Ma, Li-song Teng
Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery] 2005 May 1, 43 (9): 579-83

OBJECTIVE: To summarize the experience of surgical resection, and to analyze the prognostic factors that can influence the postoperative survival in patients with small hepatocellular carcinoma (small HCC) of </= 3 cm in diameter.

METHODS: The clinicopathologic data of 105 cases with small HCC after resection between 1986 and 2003 were analyzed, all of which had been followed up for more than half a year (median time, 33 months). Nine clinicopathologic factors including preoperative alpha-fetoprotein (AFP) level, liver cirrhosis, Child-Pugh score, tumor size (> 2 cm vs. </= 2 cm) and number (single vs. multiple), capsule formation, portal vein tumor thrombi (PVTT), Edmondson tumor grade and surgical method were analyzed through the way of Log-rank and Cox Regression tests.

RESULTS: Postoperatively, the cumulative survival rate of 1, 3 and 5-year were 86.5%, 70.3% and 55.2% respectively, and the disease-free survival rate of 1, 3 and 5-year were 78.0%, 58.9% and 45.6% respectively. One patient died from esophagogastric variceal hemorrhage in 2 weeks after re-operation. Up to the time of following up, 36 had intrahepatic recurrence or metastases postoperatively. Thirty-four patients died, of which, 4 died from variceal hemorrhage, 1 from liver failure, 1 died of pneumonia and 2 from distant metastases, while the others died from intrahepatic recurrences or metastases. Kaplan-Meier and multivariate Cox Regression tests indicated that poor Child-Pugh score, tumor more than 2 cm in diameter, PVTT and multiple lesions (including satellitic lesions) were adverse factors affecting postoperative survival. Multivariate Cox Regression tests indicated that tumor size, PVTT and multiple lesions were the factors affecting postoperative disease-free survival.

CONCLUSIONS: Limited hepatectomy with a margin no less than 1 cm is an appropriate surgical approach. Adverse preoperative Child-Pugh score and postoperative intrahepatic recurrences are main factors leading to the death of patients with small HCC.

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