Long-term Outcomes after Multiple-site Resection or Combined Resection and Radiofrequency Ablation in Patients with Multiple Hepatocellular Carcinoma

다발성 간세포암 환자에서 다발 부위 간절제 또는 고주파 치료를 병합한 간절제술 후 장기 성적

  • Cho, Min-Soo (Department of Surgery, Yonsei University College of Medicine) ;
  • Choi, Gi-Hong (Department of Surgery, Yonsei University College of Medicine) ;
  • Kim, Dong-Hyun (Department of Surgery, Yonsei University College of Medicine) ;
  • Kang, Chang-Moo (Department of Surgery, Yonsei University College of Medicine) ;
  • Choi, Jin-Sub (Department of Surgery, Yonsei University College of Medicine) ;
  • Park, Young-Nyun (Department of Pathology, Yonsei University College of Medicine) ;
  • Lee, Woo-Jung (Department of Surgery, Yonsei University College of Medicine)
  • 조민수 (연세대학교 의과대학 외과학교실) ;
  • 최기홍 (연세대학교 의과대학 외과학교실) ;
  • 김동현 (연세대학교 의과대학 외과학교실) ;
  • 강창무 (연세대학교 의과대학 외과학교실) ;
  • 최진섭 (연세대학교 의과대학 외과학교실) ;
  • 박영년 (연세대학교 의과대학 병리학교실) ;
  • 이우정 (연세대학교 의과대학 외과학교실)
  • Published : 2009.12.31

Abstract

Purpose: Hepatic resection is the standard treatment for hepatocellular carcinoma (HCC). In some patients with multiple HCC, one-block resection is not feasible due to either the tumor location or the underlying liver function. In this study, we attempted to compare the outcomes of multiple - site resection or combined resection and radiofrequency ablation with those of one-block resection in patients with multiple HCC. Methods: We retrospectively reviewed 507 patients who underwent surgical resection. Among 507 patients who received surgical treatment with potentially curative aim from January 1996 to August 2006 in Yonsei University Health System, 58 patients had a radiologically detected multiple HCC. Patients with multiple HCC were divided into: group A, patients treated with one-block resection (n=40) and group B, patients with multiple-site resection or combined resection and RFA (n=18). Results: The 1-, 3- and 5-year overall survival rates for patients with single and multiple HCC were 90.2%, 76.2% and 66.7% and 82.7%, 61.4% and 37.9%, respectively (p<0.001). In group B, 6 patients received multiple-site resection and 12 patients underwent combined resection and RFA. The clinicopathological variables were not significantly different between the two groups except the distribution of multiple tumors. The postoperative complication rates for group A and B were 32.5% and 33.3%, respectively. The 1-, 3- and 5-year disease-free survival rates for group A and B were 53.0%, 27.6% and 24.1% and 18.3%, 24.1% and 18.3%, respectively (p=0.386). The overall survival rates were also not significantly different between the two group (80.0%, 59.6%, and 36.9% for group A and 88.9%, 65.7% and 39.4% for group B, p=0.528). The multivariate analysis revealed that Edmondsons-Steiner grade (III-IV) and Indocyanine green retention rate at 15 minutes (ICG R15) >10% were adverse prognostic factors for overall survival. Conclusion: Active treatments including multiple-site resection and combined resection and RFA showed similar treatment outcomes compared with one-block resection in patients with multiple HCC.

Keywords

References

  1. Fan ST, Lo CM, Liu CL, et al. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 1999; 229:322-330. https://doi.org/10.1097/00000658-199903000-00004
  2. Torzilli G, Makuuchi M, Inoue K, et al. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. Arch Surg 1999;134:984-992. https://doi.org/10.1001/archsurg.134.9.984
  3. Capussotti L, Borgonovo G, Bouzari H, Smadja C, Grange D, Franco D. Results of major hepatectomy for large primary liver cancer in patients with cirrhosis. Br J Surg 1994;81: 427-431. https://doi.org/10.1002/bjs.1800810335
  4. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 1999;30:1434-1440. https://doi.org/10.1002/hep.510300629
  5. Yamamoto J, Okada S, Shimada K, et al. Treatment strategy for small hepatocellular carcinoma: comparison of long-term results after percutaneous ethanol injection therapy and surgical resection. Hepatology 2001;34:707-713. https://doi.org/10.1053/jhep.2001.27950
  6. Chen MF, Hwang TL, Jeng LB, Jan YY, Wang CS, Chou FF. Hepatic resection in 120 patients with hepatocellular carcinoma. Arch Surg 1989;124:1025-1028. https://doi.org/10.1001/archsurg.1989.01410090031006
  7. Chen MF, Tsai HP, Jeng LB, et al. Prognostic factors after resection for hepatocellular carcinoma in noncirrhotic livers: univariate and multivariate analysis. World J Surg 2003; 27:443-447. https://doi.org/10.1007/s00268-002-6708-7
  8. Lau H, Fan ST, Ng IO, Wong J. Long term prognosis after hepatectomy for hepatocellular carcinoma: a survival analysis of 204 consecutive patients. Cancer 1998;83:2302-2311. https://doi.org/10.1002/(SICI)1097-0142(19981201)83:11<2302::AID-CNCR9>3.0.CO;2-1
  9. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334:693-699. https://doi.org/10.1056/NEJM199603143341104
  10. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001;33: 1394-1403. https://doi.org/10.1053/jhep.2001.24563
  11. Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 2002;35: 519-524. https://doi.org/10.1053/jhep.2002.32089
  12. Choi D, Lim HK, Joh JW, et al. Combined hepatectomy and radiofrequency ablation for multifocal hepatocellular carcinomas: long-term follow-up results and prognostic factors. Ann Surg Oncol 2007;14:3510-3518. https://doi.org/10.1245/s10434-007-9492-7
  13. Ho MC, Huang GT, Tsang YM, et al. Liver resection improves the survival of patients with multiple hepatocellular carcinomas. Ann Surg Oncol 2009;16:848-855. https://doi.org/10.1245/s10434-008-0282-7
  14. Pawlik TM, Izzo F, Cohen DS, Morris JS, Curley SA. Combined resection and radiofrequency ablation for advanced hepatic malignancies: results in 172 patients. Ann Surg Oncol 2003;10:1059-1069. https://doi.org/10.1245/ASO.2003.03.026
  15. Raut CP, Izzo F, Marra P, et al. Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis. Ann Surg Oncol 2005; 12:616-628. https://doi.org/10.1245/ASO.2005.06.011
  16. Wang BW, Mok KT, Liu SI, et al. Is hepatectomy beneficial in the treatment of multinodular hepatocellular carcinoma? J Formos Med Assoc 2008;107:616-626. https://doi.org/10.1016/S0929-6646(08)60179-5
  17. Befeler AS, Di Bisceglie AM. Hepatocellular carcinoma: diagnosis and treatment. Gastroenterology 2002;122:1609-1619. https://doi.org/10.1053/gast.2002.33411
  18. Makuuchi M, Kosuge T, Takayama T, et al. Surgery for small liver cancers. Semin Surg Oncol 1993;9:298-304. https://doi.org/10.1002/ssu.2980090404
  19. Lise M, Bacchetti S, Da Pian P, Nitti D, Pilati PL, Pigato P. Prognostic factors affecting long term outcome after liver resection for hepatocellular carcinoma: results in a series of 100 Italian patients. Cancer 1998;82:1028-1036. https://doi.org/10.1002/(SICI)1097-0142(19980315)82:6<1028::AID-CNCR4>3.0.CO;2-A
  20. Yoshida Y, Kanematsu T, Matsumata T, Takenaka K, Sugimachi K. Surgical margin and recurrence after resection of hepatocellular carcinoma in patients with cirrhosis. Further evaluation of limited hepatic resection. Ann Surg 1989;209: 297-301. https://doi.org/10.1097/00000658-198903000-00008
  21. Guglielmi A, Ruzzenente A, Valdegamberi A, et al. Radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma in cirrhosis. J Gastrointest Surg 2008;12:192-198. https://doi.org/10.1007/s11605-007-0392-8
  22. Ariizumi S, Takasaki K, Yamamoto M, Ohtsubo T, Katsuragawa H, Katagiri S. Histopathologic differentiation of the main nodule determines outcome after hepatic resection for synchronous multicentric hepatocellular carcinomas. Hepatogastroenterology 2004;51:500-504.
  23. Wang J, Li Q, Sun Y, et al. Clinicopathologic features between multicentric occurence and intrahepatic metastasis of multiple hepatocellular carcinomas related to HBV. Surg Oncol 2009;18:25-30. https://doi.org/10.1016/j.suronc.2008.05.009
  24. Korean Liver Cancer Study Group. The General Rules for the Study of Primary Liver Cancer. The 2nd Edition, 2004.
  25. Poon RT, Fan ST, Ng IO, Lo CM, Liu CL, Wong J. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer 2000;89:500-507. https://doi.org/10.1002/1097-0142(20000801)89:3<500::AID-CNCR4>3.0.CO;2-O