| Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide; the number of patients diagnosed with HCC has increased worldwide. Estimates from the year 2000 indicate that HCC remains the fifth most common malignancy in men and the eighth in women worldwide. Surgical resection is a potentially curative treatment, and is still the method of first choice in China and many other countries. With the increased use of routine ultra-sonographic screening of patients with cirrhosis and hepatitis, earlier diagnosis identifies a larger number of suitable subjects for resection; and with development of surgical techniques and perioperative management, resection of HCC had become a safe operation with very low operative mortality. Significant improvement of survival after resection of HCC has been achieved within the past 3 decades. In Southeast Asia and China, HCC is mainly association with viral hepatitis B and cirrhosis, the long-term prognosis remains poor. The rate of recurrence, especially in the remnant liver, is still high. This affects survival and is an important cause of mortality. It is very important in clinic to improve the effect of resection of HCC. With the evolution of liver transplantation techniques, Transplantation performance based on the Milan criteria (solitary liver nodule not exceeding 5 cm in maximum diameter, or 2–3 tumors not exceeding 3 cm in diameter) has been shown to achieve very good disease-free survival. Liver transplantation is the best treatment option for patients with HCC and decompensated liver disease. A high dropout rate from tumor progression due to the organ shortage was identified as a major factor hampering survival in patients with early HCC listed for transplantation. The proportion of drop-outs (because of death or appearance of contraindications) is nowadays around 15%. So, it is important to idendify the patient who eligible to resection. In this study, 207 patients of HCC from Jan. 2002 to Sep. 2003 managed in our hospital were analyzed retrospectively; the risk factors of recurrence and survival after curative hepatic resection for HBV-related HCC were evaluated to identify the appropriate strategies of treatment.1 Analyze factors of survival after resection of hepatocellular carcinomaObjective: To analyze clinical factors influencing the prognosis in patients with HCC after curative resection. Methods: From January 2002 to December 2003, One hundred and eighty-two patients who underwent curative hepatectomy for HCC in our department were enrolled for reviewing clinical factors. Life table method was used to analyze survival rate (SR),Log-rank test was used for statistical comparison.Cox regression model was used for multivariate analysis. Results: The 3,5-year cumulative SR of the whole group was 61.9%, 38.7%, respectively, Multivariate analysis showed that AST (< 40 IU/L, 40-80 IU/L or > 80IU/L, P=0.004), capsule (absent / present, P<0.001),number of tumors (solitary / multiple,P=0.001), perioperative blood transfusion ( no / < 800ml or≥800ml, P=0.001) were independent prognostic factors of hepatocellular carcinoma. Conclusions: AST level, tumor capsule, number of tumors and perioperative blood transfusion were independent prognostic factors of hepatocellular carcinoma.2 Analyze factors of recurrence after resection of hepatocellular carcinomaObjective: To analyze clinical factors influencing the recurrence in patients with hepatocellular carcinoma after curative resection. Methods: From January 2002 to December 2003, One hundred and eighty-two patients who underwent curative hepatectomy for HCC in our department were enrolled for reviewing clinical factors. Risk factors for recurrence were analyzed. Multivariate analysis of risk factors for recurrence was performed using the stepwise logistic regression model. Results: The 1, 3 and 5-year cumulative survival rate of partients with recurrence was 79.2%, 40.0% and 17.1%, respectively. The 1, 3 and 5-year cumulative survival rate of partients without recurrence was 87.3%, 85.5% and 78.0%, respectively. Multivariate analysis showed that capsule (absent / present) was independent factors of recurrence.Conclusions: Patients without recurrence may result in good prognosis after curative resection. Tumor size large than 5cm, absent capsule and microvascular invasion were risk factors of recurrence. AST level, tumor capsule, number of tumors and perioperative blood transfusion were independent prognostic factors of hepatocellular carcinoma.3 Analyze of hepatic resection for Barcelona Clinic Liver Cancer Classification (BCLC) stage 0/A and B hepatocellular carcinomaObjective: To analyze the prognostic factors for hepatic resection of BCLC stage 0/A HCC and B HCC. Methods: From January 2002 to December 2003, the clinical data of 207 patients with hepatocellular carcinoma treated with hepatic resection was analyzed. 56 patients with BCLC stage 0/A HCC and 106 with BCLC stage B HCC. Life table method was used to analyze survival rate (SR) , Log-rank test was used for statistical comparison.Cox regression model was used for multivariate analysis. Results: Patients with BCLC stage 0/A HCC survival rate survival rate at 1 and 3 years were 86% and 71%. Patients with BCLC stage B HCC survival rate survival rate at 1 and 3 years were 80% and 48%. The 1- and 3-year disease-free survival of patients with BCLC stage B HCC was poorer than with BCLC stage 0/A HCC (52% and 34% vs.78% and 68%, P<0.001). Presence tumor capsule and without peri-operation transfusion were significant independent favorable prognostic factors (P=0.003 and <0.001, respectively. Conclusion: This study demonstrated hepatic resection of patients with BCLC stage B HCC is safe and effective. The HCC in BCLC stage B present capsule, hepatic resection can result in a good prognosis. Peri-operation blood transfusion should avoid in patients with HCC, particularly those with BCLC stage B.4 Survival after resection of small hepatocellular carcinoma conformable to Milan's criteria in patients with preserved liver function and analysis of treatment StrategyObjective: To analyze the prognostic factors for hepatic resection of small hepatocellular carcinoma conformable to Milan's criteria in patients with preserved liver function and the treatment strategy. Methods: From January 2002 to December 2003, the clinical data of 74 patients with small hepatocellular carcinoma conformable to Milan's criteria and preserved liver function treated with hepatic resection was analyzed. The prognostic factors of host, tumor and operation were analyzed by univariate and multivariate factors analysis of log-rank test and Cox regression model. Results: The overall survival rate and disease-free survival rate at 5 years were 51% and 25% respectively. The recurrence rate was 60.8%. The liver was the first site of recurrence in all of them. Presence esophageal varices and peri-operation transfusion were significant independent adverse prognostic factors. Conclusion: This study demonstrated hepatic resection of small hepatocellular carcinoma conformable to Milan's criteria in patients with preserved liver function is safe and effective. Salvage transplantation followed recurrence. This appears to be the optimal strategy with the shortage of organs. |
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