Patients who are likely to experience disease recurrence after undergoing hepatectomy for hepatocellular carcinoma (HCC) can be identified by factors that are available preoperatively, indicate the results of a Hong Kong study.
Having multifocal lesions, an alpha-fetoprotein (AFP) level greater than 100 ng/mL, and a history of tumor rupture all significantly increased the chances of disease recurrence in this population, reports the research team.
They recommend therefore that these "important parameters should be considered before and after contemplating curative resection for HCC patients and for risk stratification in future clinical trials for neoadjuvant or post-resection adjuvant therapy."
The findings emerge from data for 235 HCC patients treated with hepatectomy between January 2001 and July 2007, of whom 134 developed recurrence - defined as radiologic evidence of recurrence with or without an elevated level of AFP.
Recurrence occurred after a median 50-month follow up, with the majority of patients (n=93) having intrahepatic recurrence. Of these, 16 patients underwent resection.
In multivariate analysis, adjusted for potential confounders, the risk for recurrence was 2.93-fold higher in patients with multifocal lesions compared with those who had solitary lesions, 1.74-fold higher in patients with AFP levels above versus below 100 ng/ml, and 2.84-fold higher in patients with a previous history of tumor rupture compared with those without such a history. Each of these associations was significant.
Overall survival at 1-, 3-, and 5-years posthepatectomy was 83.9%, 66.0%, and 58.1%, respectively, report the researchers, while the corresponding disease-free survival rates were 64.1%, 44.0%, and 39.0%.
Having a tumor size greater than 5 cm, a serum AFP level higher than 100 ng/ml, a serum albumin level lower than 35 g/l, intraoperative blood loss of more than 500 ml, and/or undergoing a perioperative blood transfusion were all significant independent predictors of short postoperative survival, note Charing Ching-Ning Chong (The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region) and colleagues.
"The most interesting finding of this study is that the variables associated with tumor recurrence can be identified before liver resection," they remark in The Surgeon.
"This can serve as a clinical guide for neoadjuvant therapy before we subject the high risk patients to major surgery," they conclude.
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