Concurrent Cholecystectomy Is Associated with a Lower Risk of Recurrence after Curative Resection in Early-Stage Hepatocellular Carcinoma: A 10 Year Observational Single-Center Study.

Yu-Syuan Chen,Pao-Yuan Huang,Chee-Chien Yong,Chih-Chien Yao,Ming-Chao Tsai,Chih-Chi Wang,Pei-Ming Wang,Shih-Yu Yang,Yueh-Wei Liu,Ding-Wei Chen,Ching-Hui Chuang,Yen-Po Lin

doi:10.3390/jpm11121261

Abstract

Background: Cholecystectomy has been reported to be associated with increased risk of developing hepatocellular carcinoma (HCC). However, there is little information about the impact of cholecystectomy on the outcome of HCC. Aims: To evaluate the long-term effect of concurrent cholecystectomy on recurrence and overall survival in HCC after curative hepatectomy. Patients and Methods: We retrospectively enrolled 857 patients with BCLC stage 0 or A HCC who underwent primary resection from January 2001 to June 2016. The impact of concurrent cholecystectomy on overall survival (OS) and recurrence-free survival (RFS) were analyzed by Cox’s proportional hazards models after one-to-one propensity score matching (PSM). Results: Of the 857 patients, 539 (62.9%) received concurrent cholecystectomy (cholecystectomy group) and 318 (37.1%) did not (non-cholecystectomy group). During the mean follow-up period of 75.0 months, 471 (55.0%) patients experienced recurrence, and 321 (37.5%) died. RFS and OS were not significantly different between the groups. After PSM, a total of 298 patients were enrolled in each group. RFS was significantly higher in the cholecystectomy than non-cholecystectomy group (p = 0.044). In multivariate analysis, age (p = 0.022), serum AFP (p = 0.008), liver cirrhosis (p < 0.001), diabetes (p = 0.004), tumor number (p = 0.005), tumor size (p = 0.002), histological grade (p = 0.001), microvascular invasion (p < 0.001) and cholecystectomy (p = 0.021) were independent risk factors for HCC recurrence. However, there were no significant differences in OS between the cholecystectomy and non-cholecystectomy groups. Conclusions: Concurrent cholecystectomy may reduce recurrence in early-stage HCC after curative resection. Further studies are needed to validate our results.

Highlights

Hepatocellular carcinoma (HCC), the most common primary malignancy of the liver, is the second leading cause of cancer-related deaths in the world [1]
Previous studies showed cholecystectomy was associated with an increased risk of developing hepatocellular carcinoma (HCC) [12,13,25], but whether cholecystectomy influences the outcome of patients with HCC after resection was unclear
In this study, focusing on patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 or A HCC, we found that cholecystectomy was associated with a lower rate of recurrence after curative resection in early-stage HCC

Summary

Introduction

Hepatocellular carcinoma (HCC), the most common primary malignancy of the liver, is the second leading cause of cancer-related deaths in the world [1]. Surgical resection is widely accepted as an effective treatment for patients with early-stage HCC who have well-preserved liver function. Around 50–70% of patients with HCC who undergo potentially curative surgical resection develop recurrence within 5 years [4,5,6]. Many factors are known to affect the risk of recurrence in HCC, including tumor size, alpha-fetoprotein (AFP), microvascular invasion, cirrhosis, resection margin, and the viral replication status of HBV and HCV [6,7,8,9,10]. Cholecystectomy has been reported to be associated with increased risk of developing hepatocellular carcinoma (HCC). Aims: To evaluate the long-term effect of concurrent cholecystectomy on recurrence and overall survival in HCC after curative hepatectomy.

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