Risk Factors for Intrahepatic Recurrence after Resection of Hepatocellular Carcinomas in Patients with Hepatitis B Virus Infection

  • Yoon, Myung-Hee (Department of Surgery, Gospel Hospital, College of Medicine, Kosin University) ;
  • Choi, Young-Il (Department of Surgery, Gospel Hospital, College of Medicine, Kosin University) ;
  • Park, Kwang-Kuk (Department of Surgery, Gospel Hospital, College of Medicine, Kosin University) ;
  • Shin, Dong-Hoon (Department of Surgery, Gospel Hospital, College of Medicine, Kosin University) ;
  • Lee, Chung-Han (Department of Surgery, Gospel Hospital, College of Medicine, Kosin University)
  • Published : 2011.05.30

Abstract

Purpose: Although surgical resection offers patients with HCC the chance of a cure, the post-resection tumor recurrence rate is high, with reported cumulative 5-year tumor recurrence rates ranging from 40 to 70%. The objective of this study was to investigate risk factors for intrahepatic recurrence after resection of hepatocellular carcinoma, especially in patients with hepatitis B virus infection. Methods: Between January 1999 and December 2003, 59 patients in our Hospital with hepatitis B virus infection underwent liver resection for hepatocellular carcinoma. Clinical, biological, and histopathological characteristics of these patients were collected and tested for their prognostic significance using a Chi-square test and a Student's t-test. Time to recurrence and survival rate were analyzed by the Kaplan-Meier method. Results: Of the 59 patients who underwent liver resection, 24 (41%) experienced intrahepatic recurrence. The 1-, 3-, and 5-year overall survival rates of total enrolled patients were 83%, 63%, and 42%, respectively. The 1-, 3-, and 5-year overall survival rates after recurrence were 87%, 52%, and 20%, respectively. The risk factors for early recurrence were elevated serum aspartate aminotransferase (AST) level (p=0.044) and larger tumor size (p=0.049). For late recurrence, greater tumor size (p=0.039) was the only risk factor. Conclusion: Tumor size and serum aspartate aminotransferase are risk factors of intrahepatic recurrence after resection of HCC in patients with chronic hepatitis B virus infection. This finding indicates that patients who have these risk factors should be under more careful supervision and have more aggressive follow-up.

Keywords

References

  1. Tan A, Yeh SH, Liu CJ, Cheung C, Chen PJ. Viral hepatocarcinogenesis: from infection to cancer. Liver Int 2008;28:175-188. https://doi.org/10.1111/j.1478-3231.2007.01652.x
  2. Ministry of Health and Welfare. 2002 Annual Report of the Korea Central Cancer Registry. Gyeonggi-do: Ministry of Health and Welfare; 2003.
  3. Shah SA, Greig PD, Gallinger S, et al. Factors associated with early recurrence after resection for hepatocellular carcinoma and outcomes. J Am Coll Surg 2006;202:275-283. https://doi.org/10.1016/j.jamcollsurg.2005.10.005
  4. Chen WT, Chau GY, Lui WY, et al. Recurrent hepatocellular carcinoma after hepatic resection: prognostic factors and long-term outcome. Eur J Surg Oncol 2004;30:414-420. https://doi.org/10.1016/j.ejso.2004.01.013
  5. Park KW, Park JW, Choi JI, et al. Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus-endemic area. J Gastroenterol Hepatol 2008;23:467-473. https://doi.org/10.1111/j.1440-1746.2007.05112.x
  6. Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 1999;229:216-222. https://doi.org/10.1097/00000658-199902000-00009
  7. 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
  8. Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 2004;240:698-708.
  9. Chen WT, Chau GY, Lui WY, et al. Recurrent hepatocellular carcinoma after hepatic resection: prognostic factors and long-term outcome. Eur J Surg Oncol 2004;30:414-420. https://doi.org/10.1016/j.ejso.2004.01.013
  10. Choi GH, Kim DH, Kang CM, et al. Prognostic factors and optimal treatment strategy for intrahepatic nodular recurrence after curative resection of hepatocellular carcinoma. Ann Surg Oncol 2008;15:618-629. https://doi.org/10.1245/s10434-007-9671-6
  11. Cha C, Fong Y, Jarnagin WR, Blumgart LH, DeMatteo RP. Predictors and patterns of recurrence after resection of hepatocellular carcinoma. J Am Coll Surg 2003;197:753-758. https://doi.org/10.1016/j.jamcollsurg.2003.07.003
  12. Nagasue N, Uchida M, Makino Y, et al. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology 1993;105:488-494. https://doi.org/10.1016/0016-5085(93)90724-Q
  13. Kumada T, Nakano S, Takeda I, et al. Patterns of recurrence after initial treatment in patients with small hepatocellular carcinoma. Hepatology 1997;25:87-92. https://doi.org/10.1002/hep.510250116
  14. Lupberger J, Hildt E. Hepatitis B virus-induced oncogenesis. World J Gastroenterol 2007;13:74-81. https://doi.org/10.3748/wjg.v13.i1.74
  15. Ibrahim S, Roychowdhury A, Hean TK. Risk factors for intrahepatic recurrence after hepatectomy for hepatocellular carcinoma. Am J Surg 2007;194:17-22. https://doi.org/10.1016/j.amjsurg.2006.06.051
  16. Ou DP, Yang LY, Huang GW, Tao YM, Ding X, Chang ZG. Clinical analysis of the risk factors for recurrence of HCC and its relationship with HBV. World J Gastroenterol 2005;11:2061-2066. https://doi.org/10.3748/wjg.v11.i14.2061
  17. Adachi E, Maeda T, Matsumata T, et al. Risk factors for intrahepatic recurrence in human small hepatocellular carcinoma. Gastroenterology 1995;108:768-775. https://doi.org/10.1016/0016-5085(95)90450-6
  18. van Zonneveld M, Honkoop P, Hansen BE, et al. Long-term follow-up of alpha-interferon treatment of patients with chronic hepatitis B. Hepatology 2004;39:804-810. https://doi.org/10.1002/hep.20128
  19. Choi DR, Jang MK, Moon HK, et al. Long-term follow-up of alpha-interferon treatment in patients with HBeAg-positive chronic hepatitis B. Korean J Med 2005;69:150-156.
  20. Lang H, Sotiropoulos GC, Brokalaki EI, et al. Survival and recurrence rates after resection for hepatocellular carcinoma in noncirrhotic livers. J Am Coll Surg 2007;205:27-36. https://doi.org/10.1016/j.jamcollsurg.2007.03.002
  21. Park UJ, Kim YH, Kang KJ, Lim TJ. Risk factors for early recurrence after surgical resection for hepatocellular carcinoma. Korean J Hepatol 2008;14:371-380. https://doi.org/10.3350/kjhep.2008.14.3.371
  22. Shah SA, Wei AC, Cleary SP, et al. Prognosis and results after resection of very large (> or =10 cm) hepatocellular carcinoma. J Gastrointest Surg 2007;11:589-595. https://doi.org/10.1007/s11605-007-0154-7
  23. Pawlik TM, Poon RT, Abdalla EK, et al. Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Arch Surg 2005;140:450-457. https://doi.org/10.1001/archsurg.140.5.450