Purpose: Tumor recurrence after partial hepatectomy for hepatocellular carcinoma is a major cause of death from this disease. Among those recurrences, when it occurs immediate during the postoperative period, it may due to the overt expression of pre-existing micrometastases or circulating disseminated cancer cells. Therefore; we evaluate herein the risk factors for the immediate postoperative period fatal recurrence to help establish effective preventive countermeasures against these fatal recurrences.
Methods: From 1994 to 2004, the 269 patients in this study all had greater than 6 months of follow-up after curative resection for HCC at our medical center. Those patients who had a fatal recurrence that included diffuse intra-hepatic recurrence or multiple systemic recurrence within 6 months after hepatectomy, and all of the patients who didn’t have a fatal recurrence within 6 month after resection of HCC were compared. The clinicopathological factors associated with immediate postoperative recurrence were then analyzed.
Results: The overall postoperative mortality was 1%. There were 30 patients in the immediate postoperative group (the subjective group) among the total 269 patients. Among the subjective group patients, 20 patients had diffuse intra-hepatic recurrence and remained 10 patients had multiple systemic recurrence. The mean disease free survival period of the subjective group was 3.9±1.7 months and the mean survival period after recurrence was 6.7±6.1 months. On multivariate analysis, a serum alpha-fetoprotein level greater than 1,000 ng/ml (p=0.019; odds ratio: 2.98), a tumor size greater than 6.5 cm (p=0.03; odd ratio: 2.98), and the presence of microvascular invasion (p=0.01; odd ratio: 4.89) were associated with the risk factors for immediate postoperative fatal recurrence.
Conclusion: These findings can be important indicators to establish countermeasures against immediate postoperative period fatal recurrence, and the high risk patients would also be good candidates for clinical trials with adjuvant anti-cancer treatments such as early postoperative TACE, immunotherapy, anti-angiogenic treatment and so on.
|