Prognostic impact of underlying liver fibrosis and cirrhosis after curative resection of hepatocellular carcinoma

TY - JOUR

T1 - Prognostic impact of underlying liver fibrosis and cirrhosis after curative resection of hepatocellular carcinoma

AU - Gassmann, Peter

AU - Spieker, Tilmann

AU - Haier, Joerg

AU - Schmidt, Fabian

AU - Mardin, Wolf Arif

AU - Senninger, Norbert

PY - 2010/10

Y1 - 2010/10

N2 - BACKGROUND: In the case of hepatocellular carcinoma (HCC), underlying liver pathology may not only determine the feasibility of surgery but may also affect the postsurgical outcome. We report our experience after curative liver resection for HCC in patients with normal liver, liver fibrosis, and liver cirrhosis.METHODS: A total of 72 patients after liver resection with curative intention were analyzed. Histopathologic findings of tumor-unaffected liver tissue were used for retrospective classification: group A (normal liver); group B (liver fibrosis); group C (liver cirrhosis). The groups were compared for differences in short-term surgical results, total survival, and recurrence-free survival.RESULTS: The rate of major complications was 34.7% and did not significantly differ among groups. The overall perioperative mortality rate was 9.7%, with one patient dying in group A and three patients dying in each of the other two groups. Including perioperative mortality, the median overall survival for the whole group was 37.3 months (95% confidence interval 29.3-45.2 months). The respective 1-, 2-, and 5-year survival rates for group A (n = 21) were 86%, 71%, and 50% and for group C (n = 24) 62%, 50%, and 17%. The overall survival of group B (n = 27) was intermediate (log-rank, P = 0.032). The respective recurrence-free survival rates were 76%, 42%, and 20% for group A and 39%, 13%, and 4% for group C, with group B being intermediate (log-rank, P = 0.016).CONCLUSIONS: Our data demonstrate that liver resection in the presence of compensated liver cirrhosis is feasible but associated with a significantly impaired prognosis for overall and recurrence-free survival. The management of cirrhotic patients with compensated liver function and HCC therefore also requires the opportunity for transplantation.

AB - BACKGROUND: In the case of hepatocellular carcinoma (HCC), underlying liver pathology may not only determine the feasibility of surgery but may also affect the postsurgical outcome. We report our experience after curative liver resection for HCC in patients with normal liver, liver fibrosis, and liver cirrhosis.METHODS: A total of 72 patients after liver resection with curative intention were analyzed. Histopathologic findings of tumor-unaffected liver tissue were used for retrospective classification: group A (normal liver); group B (liver fibrosis); group C (liver cirrhosis). The groups were compared for differences in short-term surgical results, total survival, and recurrence-free survival.RESULTS: The rate of major complications was 34.7% and did not significantly differ among groups. The overall perioperative mortality rate was 9.7%, with one patient dying in group A and three patients dying in each of the other two groups. Including perioperative mortality, the median overall survival for the whole group was 37.3 months (95% confidence interval 29.3-45.2 months). The respective 1-, 2-, and 5-year survival rates for group A (n = 21) were 86%, 71%, and 50% and for group C (n = 24) 62%, 50%, and 17%. The overall survival of group B (n = 27) was intermediate (log-rank, P = 0.032). The respective recurrence-free survival rates were 76%, 42%, and 20% for group A and 39%, 13%, and 4% for group C, with group B being intermediate (log-rank, P = 0.016).CONCLUSIONS: Our data demonstrate that liver resection in the presence of compensated liver cirrhosis is feasible but associated with a significantly impaired prognosis for overall and recurrence-free survival. The management of cirrhotic patients with compensated liver function and HCC therefore also requires the opportunity for transplantation.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Carcinoma, Hepatocellular

KW - Feasibility Studies

KW - Female

KW - Hepatectomy

KW - Humans

KW - Liver Cirrhosis

KW - Liver Neoplasms

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Retrospective Studies

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1007/s00268-010-0655-5

DO - 10.1007/s00268-010-0655-5

M3 - SCORING: Journal article

C2 - 20544346

VL - 34

SP - 2442

EP - 2451

JO - WORLD J SURG

JF - WORLD J SURG

SN - 0364-2313

IS - 10

ER -