Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre

G. L. Grazi, M. Cescon, M. Ravaioli, G. Ercolani, A. Gardini, M. Del Gaudio, G. Vetrone, A. Cavallari

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Abstract

Background: Differences in risk factors for survival and recurrence after liver resection for hepatocellular carcinoma (HCC) in patients with or without cirrhosis are not fully clarified. Aim: To review a single-centre experience of curative liver resections for HCC in order to evaluate clinico-pathologic features and the long-term outcome of cirrhotic and noncirrhotic patients. Methods: From 1981 to 2002, 308 curative liver resections for HCC on cirrhosis (Group 1) and 135 for HCC without cirrhosis (Group 2) were performed. The main demographic, clinicopathologic and operative parameters, as well as early results were analysed and compared. Overall and disease-free survival were evaluated. Prognostic factors for survival and for tumour recurrence were studied by univariate and multivariate analysis. Results: Group 1 had worse preoperative liver function and higher frequency of hepatitis C virus infection. In Group 2, HCC showed larger mean tumour diameter (P <0.001), poorer differentiation (P <0.05) and more frequent macrovascular invasion (P <0.05). Although more extended resections were performed in Group 2 (P <0.001), there were no differences in blood transfusions, while post-operative complication rate was higher in Group 1 (P <0.005). After 1992, in-hospital mortality was 2.9% in Group 1 and 1.1% in Group 2 (P = N.S.). The 3- and 5-year overall survival was 63.7% and 42.2% in Group 1, and 67.9% and 51% in Group 2 (P <0.05). The 3- and 5-year disease-free survival was 49.3% and 27.8% in Group 1, and 58% and 45.6% in Group 2 (P <0.005). Serum bilirubin level > 1.2 mg/dL, multiple nodules. micro and macrovascular invasion, diaphragm infiltration and blood transfusions independently affected survival in Group 1. Blood replacement was the only negative prognostic factor in Group 2. Independent risk factors for tumour recurrence were satellite nodules and resection performed before 1992 in Group 1, and age <60 in Group 2. Conclusions: Despite a more aggressive behaviour, HCC without cirrhosis led to better overall and disease-free survival compared to HCC with cirrhosis after curative liver resection. Age and intra-operative blood transfusions are the only predictors of outcome in patients without cirrhosis. The impact of the latter on long-term survival in both our groups outlines the importance of surgical technique on the results of hepatectomies.

Original languageEnglish
Pages (from-to)119-129
Number of pages11
JournalAlimentary Pharmacology and Therapeutics, Supplement
Volume17
Issue number2
Publication statusPublished - Jun 2003

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Hepatocellular Carcinoma
Fibrosis
Recurrence
Survival
Liver
Neoplasms
Blood Transfusion
Disease-Free Survival
Hepatectomy
Virus Diseases
Diaphragm
Hepacivirus
Multivariate Analysis
Age Groups
Demography

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre. / Grazi, G. L.; Cescon, M.; Ravaioli, M.; Ercolani, G.; Gardini, A.; Del Gaudio, M.; Vetrone, G.; Cavallari, A.

In: Alimentary Pharmacology and Therapeutics, Supplement, Vol. 17, No. 2, 06.2003, p. 119-129.

Research output: Contribution to journalArticle

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title = "Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre",
abstract = "Background: Differences in risk factors for survival and recurrence after liver resection for hepatocellular carcinoma (HCC) in patients with or without cirrhosis are not fully clarified. Aim: To review a single-centre experience of curative liver resections for HCC in order to evaluate clinico-pathologic features and the long-term outcome of cirrhotic and noncirrhotic patients. Methods: From 1981 to 2002, 308 curative liver resections for HCC on cirrhosis (Group 1) and 135 for HCC without cirrhosis (Group 2) were performed. The main demographic, clinicopathologic and operative parameters, as well as early results were analysed and compared. Overall and disease-free survival were evaluated. Prognostic factors for survival and for tumour recurrence were studied by univariate and multivariate analysis. Results: Group 1 had worse preoperative liver function and higher frequency of hepatitis C virus infection. In Group 2, HCC showed larger mean tumour diameter (P <0.001), poorer differentiation (P <0.05) and more frequent macrovascular invasion (P <0.05). Although more extended resections were performed in Group 2 (P <0.001), there were no differences in blood transfusions, while post-operative complication rate was higher in Group 1 (P <0.005). After 1992, in-hospital mortality was 2.9{\%} in Group 1 and 1.1{\%} in Group 2 (P = N.S.). The 3- and 5-year overall survival was 63.7{\%} and 42.2{\%} in Group 1, and 67.9{\%} and 51{\%} in Group 2 (P <0.05). The 3- and 5-year disease-free survival was 49.3{\%} and 27.8{\%} in Group 1, and 58{\%} and 45.6{\%} in Group 2 (P <0.005). Serum bilirubin level > 1.2 mg/dL, multiple nodules. micro and macrovascular invasion, diaphragm infiltration and blood transfusions independently affected survival in Group 1. Blood replacement was the only negative prognostic factor in Group 2. Independent risk factors for tumour recurrence were satellite nodules and resection performed before 1992 in Group 1, and age <60 in Group 2. Conclusions: Despite a more aggressive behaviour, HCC without cirrhosis led to better overall and disease-free survival compared to HCC with cirrhosis after curative liver resection. Age and intra-operative blood transfusions are the only predictors of outcome in patients without cirrhosis. The impact of the latter on long-term survival in both our groups outlines the importance of surgical technique on the results of hepatectomies.",
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T1 - Liver resection for hepatocellular carcinoma in cirrhotics and noncirrhotics. Evaluation of clinicopathologic features and comparison of risk factors for long-term survival and tumour recurrence in a single centre

AU - Grazi, G. L.

AU - Cescon, M.

AU - Ravaioli, M.

AU - Ercolani, G.

AU - Gardini, A.

AU - Del Gaudio, M.

AU - Vetrone, G.

AU - Cavallari, A.

PY - 2003/6

Y1 - 2003/6

N2 - Background: Differences in risk factors for survival and recurrence after liver resection for hepatocellular carcinoma (HCC) in patients with or without cirrhosis are not fully clarified. Aim: To review a single-centre experience of curative liver resections for HCC in order to evaluate clinico-pathologic features and the long-term outcome of cirrhotic and noncirrhotic patients. Methods: From 1981 to 2002, 308 curative liver resections for HCC on cirrhosis (Group 1) and 135 for HCC without cirrhosis (Group 2) were performed. The main demographic, clinicopathologic and operative parameters, as well as early results were analysed and compared. Overall and disease-free survival were evaluated. Prognostic factors for survival and for tumour recurrence were studied by univariate and multivariate analysis. Results: Group 1 had worse preoperative liver function and higher frequency of hepatitis C virus infection. In Group 2, HCC showed larger mean tumour diameter (P <0.001), poorer differentiation (P <0.05) and more frequent macrovascular invasion (P <0.05). Although more extended resections were performed in Group 2 (P <0.001), there were no differences in blood transfusions, while post-operative complication rate was higher in Group 1 (P <0.005). After 1992, in-hospital mortality was 2.9% in Group 1 and 1.1% in Group 2 (P = N.S.). The 3- and 5-year overall survival was 63.7% and 42.2% in Group 1, and 67.9% and 51% in Group 2 (P <0.05). The 3- and 5-year disease-free survival was 49.3% and 27.8% in Group 1, and 58% and 45.6% in Group 2 (P <0.005). Serum bilirubin level > 1.2 mg/dL, multiple nodules. micro and macrovascular invasion, diaphragm infiltration and blood transfusions independently affected survival in Group 1. Blood replacement was the only negative prognostic factor in Group 2. Independent risk factors for tumour recurrence were satellite nodules and resection performed before 1992 in Group 1, and age <60 in Group 2. Conclusions: Despite a more aggressive behaviour, HCC without cirrhosis led to better overall and disease-free survival compared to HCC with cirrhosis after curative liver resection. Age and intra-operative blood transfusions are the only predictors of outcome in patients without cirrhosis. The impact of the latter on long-term survival in both our groups outlines the importance of surgical technique on the results of hepatectomies.

AB - Background: Differences in risk factors for survival and recurrence after liver resection for hepatocellular carcinoma (HCC) in patients with or without cirrhosis are not fully clarified. Aim: To review a single-centre experience of curative liver resections for HCC in order to evaluate clinico-pathologic features and the long-term outcome of cirrhotic and noncirrhotic patients. Methods: From 1981 to 2002, 308 curative liver resections for HCC on cirrhosis (Group 1) and 135 for HCC without cirrhosis (Group 2) were performed. The main demographic, clinicopathologic and operative parameters, as well as early results were analysed and compared. Overall and disease-free survival were evaluated. Prognostic factors for survival and for tumour recurrence were studied by univariate and multivariate analysis. Results: Group 1 had worse preoperative liver function and higher frequency of hepatitis C virus infection. In Group 2, HCC showed larger mean tumour diameter (P <0.001), poorer differentiation (P <0.05) and more frequent macrovascular invasion (P <0.05). Although more extended resections were performed in Group 2 (P <0.001), there were no differences in blood transfusions, while post-operative complication rate was higher in Group 1 (P <0.005). After 1992, in-hospital mortality was 2.9% in Group 1 and 1.1% in Group 2 (P = N.S.). The 3- and 5-year overall survival was 63.7% and 42.2% in Group 1, and 67.9% and 51% in Group 2 (P <0.05). The 3- and 5-year disease-free survival was 49.3% and 27.8% in Group 1, and 58% and 45.6% in Group 2 (P <0.005). Serum bilirubin level > 1.2 mg/dL, multiple nodules. micro and macrovascular invasion, diaphragm infiltration and blood transfusions independently affected survival in Group 1. Blood replacement was the only negative prognostic factor in Group 2. Independent risk factors for tumour recurrence were satellite nodules and resection performed before 1992 in Group 1, and age <60 in Group 2. Conclusions: Despite a more aggressive behaviour, HCC without cirrhosis led to better overall and disease-free survival compared to HCC with cirrhosis after curative liver resection. Age and intra-operative blood transfusions are the only predictors of outcome in patients without cirrhosis. The impact of the latter on long-term survival in both our groups outlines the importance of surgical technique on the results of hepatectomies.

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