Prognostic Factors of Hepatocellular Carcinoma with Distant Metastasis after Hepatic Resection

Taichi Shuto, Kazuhiro Hirohashi, Shoji Kubo, Hiromu Tanaka, Takatsugu Yamamoto, Shigekazu Takemura, Kazuki Oba, Takahiro Uenishi, Kiyotoshi Inoue and Hiroaki Kinoshita

Department of Gastrointestinal & Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine

Purpose: Improved prognosis of resected hepatocellular carcinoma (HCC) has led to an increase in the number of patients with distant metastasis (DM). To clarify the surgical indication and treatment of DM, we analyzed 40 clinicopathologic variables related to survival after recurrence. Methods: Of 227 patients who later developed recurrence after hepatic resection in the last 10 years, 166 suffered intrahepatic recurrence and 61 DM. Results: The 1-year survival after recurrence in patients with hepatic recurrence alone was 77%, 3-year 48%, and 5-year 19%. That for patients with DM was 61% at 1 year, 31% at 3 years, and 15% at 5 years of survival (p=. 0042). DM sites included the bone (n=28), lung (n=20), lymph nodes (n=11), brain (n=7), adrenal gland (n=7), thoracic or abdominal wall (n=4), and peritoneum (n=3), while 43 of 61 suffered hepatic recurrence. Univariate analysis showed the positivity of alpha fetoprotein (AFP) (n=39), stage I∼III (n=53) at initial hepatic resection, younger age (n=32), treatment for hepatic recurrence (n=34), and resection for DM (n=14) at recurrence were significant independent factors. The 3 variables were found to be independent prognostic factors after recurrence by multivariate analysis were stage I∼III, treatment for hepatic recurrence, and DM resection. Conclusions: To ensure better survival after DM recurrence, the resection of distant metastatic lesions should be done whenever possible, in addition to treatment for intrahepatic recurrent lesions.

Key words
hepatocellular carcinoa, hepatic resection, distant metastasis, surgical indication

Reprint requests
Taichi Shuto Department of Gastrointestinal & Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, JAPAN

Accepted
May 23, 2001

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