Abstract
This retrospective study aimed to validate the safety and effectiveness of hepatectomy for huge hepatocellular carcinoma (HCC). Data of patients who underwent hepatectomy for HCC between January 2006 and December 2012 were reviewed. The patients were divided into three groups: huge HCC(≥ 10 cm in diameter), large HCC(≥ 5 but<10 cm in diameter) and small HCC(<5 cm in diameter). Characteristics of pre-operative patients in all three groups were homogeneously distributed except for alpha fetal protein (AFP)(p<0.001).The 30, 60, 90-day post-operative mortality rates were not different among the three groups (p=0.785, p=0.560, and p=0.549). Laboratory data at 1, 3, and 7 days after surgery also did not vary. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) rates in the huge and large HCC groups were lower than that of the small HCC group (OS: 32.5% vs 36.3% vs 71.2%, p=0.000; DFS: 20.0% vs 24.8% vs 40.7%, p=0.039), but there was no difference between the huge and large HCC groups (OS: 32.5% vs 36.3%, p=0.667; DFS: 20.0% vs 24.8%, p=0.540). In multivariate analysis, five independent poor prognostic factors that affected OS were significantly associated with worse survival (p<0.05), namely, AFP level, macrovascular invasion, Edmondsone Steiner grade, surgical margin and Ishak score. AFP level, macrovascular invasion, microvascular invasion, and surgical margin influenced disease-free survival independently (p<0.05). The safety of hepatectomy for huge HCC is similar to that for large and small HCC; and this approach for huge HCC may achieve similar long-term survival and disease-free survival as for large HCC.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide in men and the second most frequent cause of cancer death, with an annual incidence of 0.5 million worldwide
The patients were divided into three groups: huge hepatocellular carcinoma (HCC)(≥10cm in diameter), large HCC(≥5 but
The only proven potentially curative treatment for HCC is surgical treatment-either hepatic resection or liver transplantation. (Truty et al, 2010) Liver transplantation is considered in patients with small, early lesions and cirrhosis who are eligible according to the previously established Milan criteria or even the new extended University of California, San Francisco, guidelines because survival rates are low and recurrence rates are high in patients with much larger lesions (Mazzaferro et al, 1996; Ringe et al, 1989)
Summary
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide in men and the second most frequent cause of cancer death, with an annual incidence of 0.5 million worldwide. The current Barcelona Clinic Liver Cancer (BCLC) staging system excludes patients with HCC (≥10cm in diameter) from chemoembolization, and instead restricts them to sorafenib and supportive care (Forner et al, 2010) All these findings suggest that neither liver transplantation nor nonsurgical treatment are effective to treat HCC (>10cm in diameter), Asian Pacific Journal of Cancer Prevention, Vol 15, 2014 7069 and that liver resection can be used as a first-line treatment for tumor of this size level. This retrospective study aimed to validate the safety and effectiveness of hepatectomy for huge hepatocellular carcinoma (HCC). Conclusions: The safety of hepatectomy for huge HCC is similar to that for large and small HCC; and this approach for huge HCC may achieve similar long-term survival and disease-free survival as for large HCC
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