Predictive factors relating to tumor -free survival rates and the clinical management of small cancer of the liver after hepatectomy

Abstract

OBJECTIVE To ~nvestigate factors associated with tumor-free survival rates and methods of treatment for small cancer of the liver. METHODS A total 105 cases of small cancer of the liver (maximum diameter ~<5 cm in a solitary nodule or the sum of maximum diameters in double nodules ~<5 cm) were studied between 1983 and 2000. Patients were divided into an invasive group (primary tumor accompanied by any one or more of the following features: satellite nodules, venous invasion, adjacent organ involvement and double nodules) and a non-invasive group. RESULTS Three patients died from liver failure within 30 days after operation and 100 of the other patients were followed-up. The 1, 3, 5, 7 and 10-year survival rates after the first resection were 95.8%, 64.8%, 48.8%, 39.4% and 34.3% respectively. The main factors influencing tumor-free survival after radical resection were tumor size, presence or absence of satellite nodules or vascular invasion, the incisal edge, the UICC TNM stage, and the number of tumor nodules. The survival rate of the invasive group was significantly lower than that of the non-invasive group. Tumors of fifty-one cases recurred after radical resection. For the recurrent patients, treatments included a repeated resection for 17 cases, transcatheter artery chemotherapy and embolization (TACE) for 18 cases and no treatment or chemotherapy for 18 cases. The 1,3 and 5-year survival rates after repeated hepatectomy for recurrent patients were 82.4%, 51.3% and 34.2% respectively, which were higher than those in the non-resected group. CONCLUSIONS Factors that influence postoperative tumor-free survival rate were concluded to be early stage detection, tumor invasive or noninvasive traits and the incisal edge. For the recurrent patients, active treatment especially a second hepatectomy, is safe and feasible, and can improve the 5-year survival rate by 10 percent. The categorization of invasive and non-invasive groups for small cancer of the liver is useful in clinical work. For patients with invasive small cancer of the liver, postoperative close surveillance and follow-up is the key to improve the prognosis.