Long-Term Survival Outcomes After Liver Resection for Binodular Hepatocellular Carcinoma: A Multicenter Cohort Study

The oncologist

article

Ming-Da Wang¹  Zhen-Li Li¹  Xin-Fei Xu¹  Ting-Hao Chen²  Ya-Hao Zhou³  Wei-Min Gu⁴  Hong Wang⁵  Yong-Yi Zeng⁶  Yao-Ming Zhang⁷  Timothy M. Pawlik⁸  Wan Yee Lau¹  Chao Li¹  Meng-Chao Wu¹  Jia-Mei Yang¹  Feng Shen¹  Tian Yang¹  Jun Li¹  Wan-Guang Zhang^1,10  Wei-Qin Jiang^1,11  Jiong-Jie Yu¹  Hao Xing¹  Han Wu¹  Jun Han¹ 

[1] The 1st Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University;Department of General Surgery, Ziyang First People's Hospital;Department of Hepatobiliary Surgery, Pu'er People's Hospital;The First Department of General Surgery, the Fourth Hospital of Harbin;Department of General Surgery, Liuyang People's Hospital;Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University;The Second Department of Hepatobiliary Surgery, Meizhou People's Hospital (Huangtang Hosptial), Meizhou Hospital to Sun Yat-sen University;Department of Surgery, Ohio State University, Wexner Medical Center;Faculty of Medicine, the Chinese University of Hong Kong, Prince of Wales Hospital;Department of Hepatic Surgery, Tongji Hospital, Huazhong University of Science and Technology;Cancer Biotherapy Center, First Affiliated Hospital, School of Medicine of Zhejiang University

关键词: Hepatocellular carcinoma;    Hepatectomy;    Overall survival;    Recurrence-free survival;    Multicentric origin;    Intrahepatic metastasis;   

DOI  :  10.1634/theoncologist.2018-0898

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background The long-term prognosis after liver resection for multinodular (≥3 nodules) hepatocellular carcinoma (HCC) is generally considered to be unfavorable. However, the role of liver resection for binodular HCC is less investigated. Subjects, Materials, and Methods From a multicenter database, consecutive patients who underwent curative-intent liver resection for binodular HCC and without macrovascular invasion between 2003 and 2015 were retrospectively reviewed. Patients’ clinical variables as well as perioperative and long-term survival outcomes were analyzed. Univariable and multivariable analyses were performed to identify the risk factors associated with overall survival (OS) and recurrence-free survival (RFS) after curative resection. Results Of 263 enrolled patients, the perioperative 30-day mortality and morbidity rates were 1.5% and 28.5%. The 1-, 3-, and 5-year OS and RFS rates were 81.5%, 52.4%, and 39.1% and 57.1%, 35.8%, and 26.6%, respectively. Multivariable Cox-regression analyses identified preoperative alpha-fetoprotein level >400 μg/L, tumor size with a sum of two nodules >8 cm, tumor size ratio of large/small nodule >1.5 (asymmetrical proportion), unilateral hemiliver distribution of two nodules, distance of ≤3 cm between two nodules, and microvascular invasion in any nodule as independent risk factors associated with decreased OS and RFS. Conclusion Liver resection was safe and feasible in patients with binodular HCC, with acceptable perioperative and long-term outcomes. Sum of two tumor sizes, size ratio and distribution, and distance between two nodules were independent risk factors associated with long-term survival outcomes after surgery. These results may guide clinicians to make individualized surgical decisions and estimate long-term prognosis for these patients. Implications for Practice Liver resection was safe and feasible in patients with binodular hepatocellular carcinoma, with acceptable perioperative and long-term outcomes. The sum of two tumor sizes, the size ratio and distribution of the two nodules, and the distance between two nodules were independent risk factors associated with long-term overall survival and recurrence-free survival after liver resection. The results of this study may guide clinicians to make individualized surgical decisions, estimate long-term prognosis, and plan recurrence surveillance and adjuvant therapy for these patients.

【 授权许可】

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