The Risk Factors And Therapeutic Strategies For Early And Late Recurrence After Resection Of Large Hepatocellular Carcinoma

BackgroundThe hepatocellular carcinoma (HCC) is one of the most common types of cancer in the world, with an annual incidence of approximately 1 million cases. Resection of HCC has become a safe operation with low operative mortality recently as a result of advances in both surgical and perioperative management. However, the long term prognosis still remains unsatisfactory, due to an extremely high recurrence, even after curative resection. Identifying and treating recurrent liver cancer is one of most important strategies for improving the overall survival for patients with liver cancer undergoing curative resection. During the past decade, tremendous efforts have been made to study the risk factors and prognostic factors relate to post-hepatectomy recurrence or survival, butlittle has been documented on the characteristics and risk factors of large HCC (>5 cm) patients with recurrence. Because that resection of a large HCC is a surgical challenge that entails a greater operating time, blood loss, risk of postoperative liver failure, as well as the perceived poor prognosis. Furthermore, whether there are specific biological features relate to the development of a large HCC remains disputation. ObjectiveTo explore risk factors influence recurrence after resection of hepatocellular carcinoma (HCC) and effective methods of therapy. MethodsFrom January 1997 to December 2002, 169 patients who underwent complete resection of HCC were enrolled for reviewing their clinical characteristics, histopathologic features and treatment. Eighteen parameters contributing to recurrence were analyzed. ResultsAmong the 76(44.6%) patients with recurrence, 52 had early recurrence and 24 had late recurrence. AFP and venous invasion were risk factors for early recurrence, whereas, cirrhosis was the only significant risk factor for late recurrence. The overall 1-, 3-year survival rate after early recurrence were 69.3% and 14.3%, which were worsethan the corresponding survival rate of 100% and 29.6% after late recurrence. Despite the treatment were similar between the two groups, The overall 1- and 3-year survival rates were 94.7% and 52.6%, respectively, in surgical patients, and for nonsurgical patients, were 71.9% and 7.1%. ConclusionThe identification of significant risk factors for recurrence may not only improve patient selection for resection of HCC but also enable better selection of patients for postoperative adjuvant tiierapy. Proper intervention which was selected was effective for patients with recurrent HCC. Contrasting with other interventions, operation after recurrence can prolong the survival time obviously. Liver transplantation is a substitutive operative procedure for recurrent HCC worthy of study.