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Original Investigation
January 4, 2017

Effect of Background Liver Cirrhosis on Outcomes of Hepatectomy for Hepatocellular Carcinoma

Author Affiliations
  • 1Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
  • 2Hepatobiliary Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan
  • 3Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
JAMA Surg. Published online January 4, 2017. doi:10.1001/jamasurg.2016.5059
Key Points

Question  What is the pattern and recurrence rate of de novo hepatocellular carcinoma among patients with liver cirrhosis and normal liver after resection of hepatocellular carcinoma?

Findings  The median annual incidence of postoperative recurrence of hepatocellular carcinoma within 5 years after surgery was lower in the group with normal liver (5.9%) compared with the group with liver cirrhosis (12.7%). Multiple recurrences near the resection margin or at extrahepatic sites were more frequent in the group with normal liver (50.0% vs 15.4%), whereas solitary recurrence at a distant site was more common in the group with liver cirrhosis (53.8% vs 5.6%).

Meaning  Comparison of the patterns and annual incidence of recurrence of hepatocellular carcinoma demonstrated that the poorer prognosis in the group with liver cirrhosis was likely owing to a higher hepatocarcinogenic potential among patients with cirrhosis.

Abstract

Importance  Background hepatocarcinogenesis is considered a major cause of postoperative recurrence of de novo hepatocellular carcinoma (HCC) in patients with liver cirrhosis (LC). The degree of underlying liver injury has reportedly correlated with surgical outcomes of HCC. However, the pattern and annual rate of recurrence of postoperative de novo HCC are still unclear.

Objective  To clarify the pattern and rate of recurrence of de novo HCC in patients with LC.

Design, Setting, and Participants  Data from 799 patients who underwent curative hepatectomy for HCC at Toranomon Hospital and The Johns Hopkins Hospital between January 1, 1995, and December 31, 2014, were retrospectively collected and analyzed. Of the patients who underwent curative hepatectomy for HCC, 424 met inclusion criteria: 73 with normal liver (NL) and 351 with LC. Sixty-four patients who had histologically proven NL parenchyma were matched with an equal number of patients who had established LC, and postoperative outcomes were compared.

Interventions  Hepatectomy in patients with HCC.

Main Outcomes and Measures  Patterns of recurrence of HCC and chronological changes in recurrence rates.

Results  Among 128 matched patients in the study (mean [SD] age, 64.0 [12.7] years; 93 men and 35 women) 1-, 3-, and 5-year cumulative recurrence was 17.2%, 23.0%, and 37.5%, respectively, in the NL group vs 25.0%, 55.5%, and 72.1%, respectively, in the LC group (P = .001). The 3- and 5-year disease-specific survival was 85.7% and 75.4%, respectively, in the NL group vs 74.9% and 59.1%, respectively, in the LC group (P = .04). The median annual incidence of postoperative recurrence of HCC within 5 years after surgery was lower in the NL group (5.9%) compared with the LC group (12.7%) (P = .003). Assessment of recurrence patterns revealed that multiple recurrences near the resection margin or at extrahepatic sites were more frequent in the NL group (9 [50.0%] vs 6 [15.4%]; P = .01), whereas solitary recurrence at a distant site was more common in the LC group (21 [53.8%] vs 1 [5.6%]; P < .001).

Conclusions and Relevance  Comparison of the patterns and annual incidence of recurrence of HCC demonstrated that the poorer prognosis in the LC group was likely owing to a higher hepatocarcinogenic potential among patients with cirrhosis. Annual recurrence rates in the 2 groups indicate that de novo recurrence may continuously occur from the early postoperative period until the late period after resection of HCC.

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