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Prognostic factors after liver resection for hepatocellular carcinoma with hepatitis B virus-related cirrhosis: The surgeons role in survival
European Journal of Surgical Oncology, 05/13/09

Zhang XF et al. - In a study to investigate the controllable and uncontrollable poor prognostic factors for hepatectomy in pts with hepatitis B virus (HBV)-related cirrhosis, it appears that survival of hepatocellular carcinoma (HCC) pts with HBV-related cirrhosis after liver resection depends on preoperative liver reserve, tumor status, and blood transfusion. Tumor status cannot be altered; however, the surgeon can do a great favor to the prognosis of pts by minimizing bleeding and blood transfusion. Pts with 2 or more preoperative risk factors should be cautiously selected for liver resection.

Methods

Clinical and pathological data of 412 HCC pts with HBV-related cirrhosis undergoing liver resection were retrospectively reviewed.
Prognostic risk factors were analyzed by univariate and multivariate analyses.
Cumulative survival was calculated with respect to number of prognostic risk factors.

Results

Significant risk factors for decreasing both overall (OS) and disease-free survival of pts were: ascites volume of >500 ml; prothrombin time of >4 s; serum AFP of >400 ng/ml; tumor distribution in 2 lobes; vascular invasion; capsule absence; and blood transfusion of >600 ml.
Female gender and operation time of >5 h are risk factors of tumor recurrence but not for pts' OS.
3-yr survival rate decreased from 100% to 0 as number of risk factors in pts increased from 0 to 4 or more.
Pts who had 2 or more preoperative risk factors were poor candidates for liver resection, with 3-yr survival rate of 8.5%.

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