Prognostic factors affecting disease-free survival after hepatic resection for hepatocellular carcinoma in cirrhotic liver

Aims
Hepatic resections for hepatocellular carcinoma (HCC) in the cirrhotic liver are characterized by early recurrence. In this study, we analyzed several factors affecting disease-free survival after hepatic resection.
Settings and design
A retrospective and prospective study.
Materials and methods
From January 2002 to July 2012, 208 patients underwent hepatic resections for HCC in the cirrhotic liver in the Gastroenterology Surgical Center, Mansoura University, Egypt. There were 157 male (75.5%) and 51 female (24.5%) patients, with a mean age of 55.4 ± 9.3 years. Recurrence rates were analyzed using the Kaplan-Meier curve. The prognostic significance of the tested factors was investigated by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards model. Statistical analysis was performed using SPSS18.
Results
Most patients were in Child-Pugh class A (88%). Major hepatic resection was performed in 73 patients (35.1%), segmentectomy was performed in 74 patients (35.6%), and localized resection was performed in 61 patients (29.3%). Hospital mortality occurred in 19 (9.1%) patients, whereas hospital morbidity occurred in 37% of the patients. The 1-, 3-, and 5-year survivals were 62.9, 25.9, and 19.1%, respectively. The prognostic factors predicting early tumor recurrence were the Child class, multifocality, portal vein (PV) invasion, perioperative blood transfusion, microvascular invasion, local spread, cut margin infiltration, lymph node infiltration, lack of a capsule, the tumor grade, the tumor stage, and preoperative alpha feto protein (AFP). However, tumor multifocality, perioperative blood transfusion, and cut margin infiltration were the main factors predicting early recurrence on multivariate analysis.
Conclusion
Factors predicting disease-free survival are different and multifactorial. However, the resection of HCC in a cirrhotic liver with preserved liver function is the treatment of choice and can be performed with favorable results.