Abstract
The prognosis of patients with hepatocellular carcinoma (HCC) after curative resection varies greatly. Few studies had investigated the risk factors for early recurrence (recurrence-free time ≤ 1 year) of hepatitis B virus (HBV)-related HCCs meeting Milan criteria. A retrospective analysis was performed on the 224 patients with HCC meeting Milan criteria who underwent curative liver resection in our center between February 2007 and March 2012. The overall survival (OS) rate, recurrence-free survival (RFS) rate and risk factors for early recurrence were analyzed. After a median follow-up of 33.3 months, HCC reoccurred in 105 of 224 patients and 32 died during the period. The 1-, 3- and 5-year OS rates were 97.3%, 81.6% and 75.6% respectively, and the 1-, 3- and 5-year RFS rates were 73.2%, 53.7% and 41.6%. Cox regression showed alpha-fetoprotein (AFP) > 800 ng/ml (HR 2.538, 95% CI 1.464-4.401, P=0.001), multiple tumors (HR 2.286, 95% CI 1.123-4.246, P=0.009) and microvascular invasion (HR 2.518, 95% CI 1.475-4.298, P=0.001) to be associated with early recurrence (recurrence-free time ≤ 1-year) of HCC meeting Milan criteria. AFP > 800 ng/ml, multiple tumors and microvascular invasion are independent risk factors affecting early postoperative recurrence of HCC. In addition resection appears capable of replacing liver transplantation in some situations with safety and a better outcome.
Highlights
Milan criteria, proposed in 1996 (Mazzaferro et al, 1996), was widely accepted as a standard for liver transplantation (LT) because of its satisfactory outcome
A retrospective analysis was performed on the 224 patients with hepatocellular carcinoma (HCC) meeting Milan criteria who underwent curative liver resection in our center between February 2007 and March 2012
A recent study suggested that resection could achieve the similar 5-year overall survival (OS) rate as LT did but HCC recurred more frequently after resection than it did after LT (Lee et al, 2010)
Summary
Milan criteria (single tumor ≤ 5 cm, or showing up to 3 nodulars and each nodular ≤ 3 cm, without neither major vascular invasion nor distant metastasis), proposed in 1996 (Mazzaferro et al, 1996), was widely accepted as a standard for liver transplantation (LT) because of its satisfactory outcome. Due to the shortage of liver donation and the limited waiting time with tumor progression, most of the patients were compromised to undergo resection. For those patients with preserved liver function, hepatectomy can be performed with relatively less technically difficult and timely convenient. Rare studies focused on postoperative early recurrence (recurrence within 1 year) of HCC meeting Milan Criteria. We sought to retrospectively analyze the clinical outcome of 224 patients with HBV-related HCC fulfilling Milan Criteria, who had been treated by primary curative resection, and to identify what kind of factors would lead to the early recurrence.
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