Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1999 Feb;229(2):216–222. doi: 10.1097/00000658-199902000-00009

Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors.

R T Poon 1, S T Fan 1, C M Lo 1, C L Liu 1, J Wong 1
PMCID: PMC1191634  PMID: 10024103

Abstract

OBJECTIVE: This study aimed to evaluate the long-term results of treatment and prognostic factors in patients with intrahepatic recurrence after curative resection of hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: Recent studies have demonstrated the usefulness of re-resection, transarterial oily chemoembolization (TOCE), or percutaneous ethanol injection therapy (PEIT) in selected patients with intrahepatic recurrent HCC. The overall results of a treatment strategy combining these modalities have not been fully evaluated, and the prognostic factors determining survival in these patients remain to be clarified. METHODS: Two hundred and forty-four patients who underwent curative resection for HCC were followed for intrahepatic recurrence, which was treated aggressively with a strategy including different modalities. Survival results after recurrence and from initial hepatectomy were analyzed, and prognostic factors were determined by univariate and multivariate analysis using 27 clinicopathologic variables. RESULTS: One hundred and five patients (43%) with intrahepatic recurrence were treated with re-resection (11), TOCE (71), PEIT (6), systemic chemotherapy (8) or conservatively (9). The overall 1-year, 3-year, and 5-year survival rates from the time of recurrence were 65.5%, 34.9%, and 19.7%, respectively, and from the time of initial hepatectomy were 78.4%, 47.2%, and 30.9%, respectively. The re-resection group had the best survival, followed by the TOCE group. Multivariate analysis revealed Child's B or C grading, serum albumin < or = 40 g/l, multiple recurrent tumors, recurrence < or = 1 year after hepatectomy, and concurrent extrahepatic recurrence to be independent adverse prognostic factors. CONCLUSIONS: Aggressive treatment with a multimodality strategy could result in prolonged survival in patients with intrahepatic recurrence after curative resection for HCC. Prognosis was determined by the liver function status, interval to recurrence, number of recurrent tumors, any concurrent extrahepatic recurrence, and type of treatment.

Full text

PDF
216

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arii S., Tanaka J., Yamazoe Y., Minematsu S., Morino T., Fujita K., Maetani S., Tobe T. Predictive factors for intrahepatic recurrence of hepatocellular carcinoma after partial hepatectomy. Cancer. 1992 Feb 15;69(4):913–919. doi: 10.1002/1097-0142(19920215)69:4<913::aid-cncr2820690413>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  2. Chen P. J., Chen D. S., Lai M. Y., Chang M. H., Huang G. T., Yang P. M., Sheu J. C., Lee S. C., Hsu H. C., Sung J. L. Clonal origin of recurrent hepatocellular carcinomas. Gastroenterology. 1989 Feb;96(2 Pt 1):527–529. doi: 10.1016/0016-5085(89)91581-3. [DOI] [PubMed] [Google Scholar]
  3. Ikeda K., Kumada H., Saitoh S., Arase Y., Chayama K. Effect of repeated transcatheter arterial embolization on the survival time in patients with hepatocellular carcinoma. An analysis by the Cox proportional hazard model. Cancer. 1991 Nov 15;68(10):2150–2154. doi: 10.1002/1097-0142(19911115)68:10<2150::aid-cncr2820681011>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  4. Jwo S. C., Chiu J. H., Chau G. Y., Loong C. C., Lui W. Y. Risk factors linked to tumor recurrence of human hepatocellular carcinoma after hepatic resection. Hepatology. 1992 Dec;16(6):1367–1371. doi: 10.1002/hep.1840160611. [DOI] [PubMed] [Google Scholar]
  5. Ko S., Nakajima Y., Kanehiro H., Hisanaga M., Aomatsu Y., Kin T., Yagura K., Ohyama T., Nishio K., Ohashi K. Significant influence of accompanying chronic hepatitis status on recurrence of hepatocellular carcinoma after hepatectomy. Result of multivariate analysis. Ann Surg. 1996 Nov;224(5):591–595. doi: 10.1097/00000658-199611000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kotoh K., Sakai H., Morotomi I., Nawata H. The use of percutaneous ethanol injection therapy for recurrence of hepatocellular carcinoma. Hepatogastroenterology. 1995 Jul;42(3):197–200. [PubMed] [Google Scholar]
  7. Kumada T., Nakano S., Takeda I., Sugiyama K., Osada T., Kiriyama S., Sone Y., Toyoda H., Shimada S., Takahashi M. Patterns of recurrence after initial treatment in patients with small hepatocellular carcinoma. Hepatology. 1997 Jan;25(1):87–92. doi: 10.1053/jhep.1997.v25.pm0008985270. [DOI] [PubMed] [Google Scholar]
  8. Lai E. C., Fan S. T., Lo C. M., Chu K. M., Liu C. L., Wong J. Hepatic resection for hepatocellular carcinoma. An audit of 343 patients. Ann Surg. 1995 Mar;221(3):291–298. doi: 10.1097/00000658-199503000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Lai E. C., Lo C. M., Fan S. T., Liu C. L., Wong J. Postoperative adjuvant chemotherapy after curative resection of hepatocellular carcinoma: a randomized controlled trial. Arch Surg. 1998 Feb;133(2):183–188. doi: 10.1001/archsurg.133.2.183. [DOI] [PubMed] [Google Scholar]
  10. Lee P. H., Lin W. J., Tsang Y. M., Hu R. H., Sheu J. C., Lai M. Y., Hsu H. C., May W., Lee C. S. Clinical management of recurrent hepatocellular carcinoma. Ann Surg. 1995 Nov;222(5):670–676. doi: 10.1097/00000658-199511000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lygidakis N. J., Pothoulakis J., Konstantinidou A. E., Spanos H. Hepatocellular carcinoma: surgical resection versus surgical resection combined with pre- and post-operative locoregional immunotherapy-chemotherapy. A prospective randomized study. Anticancer Res. 1995 Mar-Apr;15(2):543–550. [PubMed] [Google Scholar]
  12. Matsuda Y., Ito T., Oguchi Y., Nakajima K., Izukura T. Rationale of surgical management for recurrent hepatocellular carcinoma. Ann Surg. 1993 Jan;217(1):28–34. doi: 10.1097/00000658-199301000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Matsumata T., Kanematsu T., Takenaka K., Yoshida Y., Nishizaki T., Sugimachi K. Patterns of intrahepatic recurrence after curative resection of hepatocellular carcinoma. Hepatology. 1989 Mar;9(3):457–460. doi: 10.1002/hep.1840090320. [DOI] [PubMed] [Google Scholar]
  14. Mazzaferro V., Regalia E., Doci R., Andreola S., Pulvirenti A., Bozzetti F., Montalto F., Ammatuna M., Morabito A., Gennari L. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996 Mar 14;334(11):693–699. doi: 10.1056/NEJM199603143341104. [DOI] [PubMed] [Google Scholar]
  15. Mise M., Arii S., Higashituji H., Furutani M., Niwano M., Harada T., Ishigami S., Toda Y., Nakayama H., Fukumoto M. Clinical significance of vascular endothelial growth factor and basic fibroblast growth factor gene expression in liver tumor. Hepatology. 1996 Mar;23(3):455–464. doi: 10.1053/jhep.1996.v23.pm0008617424. [DOI] [PubMed] [Google Scholar]
  16. Nagasue N., Kohno H., Hayashi T., Uchida M., Ono T., Yukaya H., Yamanoi A. Repeat hepatectomy for recurrent hepatocellular carcinoma. Br J Surg. 1996 Jan;83(1):127–131. doi: 10.1002/bjs.1800830142. [DOI] [PubMed] [Google Scholar]
  17. Nagasue N., Uchida M., Makino Y., Takemoto Y., Yamanoi A., Hayashi T., Chang Y. C., Kohno H., Nakamura T., Yukaya H. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology. 1993 Aug;105(2):488–494. doi: 10.1016/0016-5085(93)90724-q. [DOI] [PubMed] [Google Scholar]
  18. Nakoa N., Kamino K., Miura K., Hayashi T., Ohnishi M., Takayasu Y., Miura T., Okamoto E. Recurrent hepatocellular carcinoma after partial hepatectomy: value of treatment with transcatheter arterial chemoembolization. AJR Am J Roentgenol. 1991 Jun;156(6):1177–1179. doi: 10.2214/ajr.156.6.1851379. [DOI] [PubMed] [Google Scholar]
  19. Neeleman N., Andersson R. Repeated liver resection for recurrent liver cancer. Br J Surg. 1996 Jul;83(7):893–901. doi: 10.1002/bjs.1800830705. [DOI] [PubMed] [Google Scholar]
  20. Nonami T., Isshiki K., Katoh H., Kishimoto W., Harada A., Nakao A., Takagi H. The potential role of postoperative hepatic artery chemotherapy in patients with high-risk hepatomas. Ann Surg. 1991 Mar;213(3):222–226. doi: 10.1097/00000658-199103000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Norton J. A. Tumor angiogenesis. The future is now. Ann Surg. 1995 Dec;222(6):693–694. doi: 10.1097/00000658-199512000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Okazaki M., Yamasaki S., Ono H., Higashihara H., Koganemaru F., Kimura S., Kuroda Y., Sato S., Ryu K., Ohtsubo T. Chemoembolotherapy for recurrent hepatocellular carcinoma in the residual liver after hepatectomy. Hepatogastroenterology. 1993 Aug;40(4):320–323. [PubMed] [Google Scholar]
  23. Okuda K., Ohtsuki T., Obata H., Tomimatsu M., Okazaki N., Hasegawa H., Nakajima Y., Ohnishi K. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer. 1985 Aug 15;56(4):918–928. doi: 10.1002/1097-0142(19850815)56:4<918::aid-cncr2820560437>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  24. Ono T., Nagasue N., Kohno H., Hayashi T., Uchida M., Yukaya H., Yamanoi A. Adjuvant chemotherapy with epirubicin and carmofur after radical resection of hepatocellular carcinoma: a prospective randomized study. Semin Oncol. 1997 Apr;24(2 Suppl 6):S6–18-S6-25. [PubMed] [Google Scholar]
  25. Shimada M., Matsumata T., Taketomi A., Yamamoto K., Itasaka H., Sugimachi K. Repeat hepatectomy for recurrent hepatocellular carcinoma. Surgery. 1994 Jun;115(6):703–706. [PubMed] [Google Scholar]
  26. Shimada M., Takenaka K., Gion T., Fujiwara Y., Kajiyama K., Maeda T., Shirabe K., Nishizaki T., Yanaga K., Sugimachi K. Prognosis of recurrent hepatocellular carcinoma: a 10-year surgical experience in Japan. Gastroenterology. 1996 Sep;111(3):720–726. doi: 10.1053/gast.1996.v111.pm8780578. [DOI] [PubMed] [Google Scholar]
  27. Shimada M., Takenaka K., Taguchi K., Fujiwara Y., Gion T., Kajiyama K., Maeda T., Shirabe K., Yanaga K., Sugimachi K. Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg. 1998 Jan;227(1):80–85. doi: 10.1097/00000658-199801000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Suenaga M., Sugiura H., Kokuba Y., Uehara S., Kurumiya T. Repeated hepatic resection for recurrent hepatocellular carcinoma in eighteen cases. Surgery. 1994 Apr;115(4):452–457. [PubMed] [Google Scholar]
  29. Takenaka K., Yoshida K., Nishizaki T., Korenaga D., Hiroshige K., Ikeda T., Sugimachi K. Postoperative prophylactic lipiodolization reduces the intrahepatic recurrence of hepatocellular carcinoma. Am J Surg. 1995 Apr;169(4):400–405. doi: 10.1016/s0002-9610(99)80184-6. [DOI] [PubMed] [Google Scholar]
  30. Yamamoto J., Kosuge T., Takayama T., Shimada K., Yamasaki S., Ozaki H., Yamaguchi N., Makuuchi M. Recurrence of hepatocellular carcinoma after surgery. Br J Surg. 1996 Sep;83(9):1219–1222. [PubMed] [Google Scholar]
  31. Yamamoto J., Kosuge T., Takayama T., Shimada K., Yamasaki S., Ozaki H., Yamaguchi N., Mizuno S., Makuuchi M. Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery. 1994 Mar;115(3):303–309. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES