Prognostic factors after liver resection for hepatocellular carcinoma with hepatitis B virus-related cirrhosis: The surgeon's role in survival (original) (raw)
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World Journal of Surgery, 2011
Background The impact of viral factors on the prognosis of hepatocellular carcinoma (HCC) remains controversial because of heterogeneous populations included in previous reports. This study aims to compare clinicopathologic features and prognoses between patients with hepatitis B-and hepatitis C-related HCC who underwent resection surgery. Methods We enrolled 609 patients with positive serum hepatitis B virus (HBV) surface antigen (HBsAg) and negative serum antibody against hepatitis C virus (anti-HCV) as the B-HCC group and 206 patients with negative serum HBsAg and positive anti-HCV as the C-HCC group.
Prognostic factors in patients with HBV-related hepatocellular carcinoma following hepatic resection
Infectious Agents and Cancer
Background: To analyze prognostic factors following hepatic resection in patients with HBV-related hepatocellular carcinoma. Methods: We retrospectively analyzed 217 patients with HBV-related hepatocellular carcinoma who underwent hepatic resection at our hospital between January 2006 and December 2015. Disease-free survival and overall survival rates were analyzed using the Kaplan-Meier method and the log-rank test. The association between recurrence and survival and various clinicopathological factors, including serum alpha-fetoprotein (AFP) level, platelet count, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, antiplatelet therapy, antiviral therapy, hepatitis C virus infection, and tumor-related characteristics, were assessed using univariate and multivariate logistic regression analysis. Results: The 1-, 3-, and 5-year overall survival rates were 91, 84, and 79%, respectively, and the recurrence-free survival rates were 72, 51, and 44%, respectively. High post-operative AFP level (hazard ratio [HR] 1.112, 95% confidence interval [CI]: 1.02-1.21, P = 0.007), multiple tumors (HR 1.991, 95% CI: 1.11-3.56, P = 0.021), and no antiviral treatment (HR 1.823, 95% CI: 1.07-3.09, P = 0.026) were independent risk factors for recurrence. High postoperative AFP level (HR 1.222, 95% CI: 1.09-1.36, P < 0.001), multiple tumors (HR 2.715, 95% CI: 1.05-7.02, P = 0.039), and recurrence (HR 12.824, 95% CI: 1.68-97.86, P = 0.014) were independent risk factors for mortality. No other factors analyzed were associated with outcomes in this patient cohort. Conclusions: High post-operative serum alpha-fetoprotein level and multiple tumors, but not inflammatory factors, were risk factors for poor prognosis in HBV-related hepatocellular carcinoma patients after resection.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2015
BACKGROUND Hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients can develop in those with cirrhotic and non-cirrhotic liver Not only impairment of liver status, but also the extension of tumor and difference of pathogenesis may also affect characteristics of patient and tumor including survival and recurrence. OBJECTIVE To evaluate the disease free survival, prognostic factors and features of HCC after hepatic resection in CHB patients with and without cirrhosis. MATERIAL AND METHOD Two hundred fifteen HBV-related HCC patients underwent hepatic resection and were analyzed. Cirrhotic and non-cirrhotic groups were compared for differences inpatient and tumor characteristics, disease-free survival including prognostic factors. RESULTS In comparison with cirrhotic patients, non-cirrhotic patients had more family history of HCC, more preserved liver function, were less HBeAg positive, and had lower HBV viral load. HCC characteristics in non-cirrhotic groups showed signifi...
BMC Gastroenterology, 2019
Background: Prior hepatitis B virus infection (PBI) may increase the risk of developing hepatocellular carcinoma (HCC), but the impact of PBI on clinical outcomes following treatment for HCC remains unknown. The aim of this study was to clarify whether PBI affects clinical outcomes after liver resection for hepatitis C virus (HCV)-related HCC by retrospective cohort study. Methods: PBI patients were defined as those negative for hepatitis B surface antigen and positive for anti-hepatitis B core antibody. Surgical outcomes of HCV-related HCC patients with PBI were compared to those without PBI. Survival of patients with non-B non-C HCC with and without PBI were also compared. Results: In the HCV group, the median overall survival of 165 patients with PBI was 4.7 years (95% confidence interval [CI], 3.9-5.9), and was significantly shorter compared with 263 patients without PBI (6.6 years [5.3-9.8]; p = 0.015). Conversely, there was no significant difference in recurrence-free survival between the two groups (1.8 years [95% CI, 1.4-2.0] vs 2.0 years [1.7-2.3]; p = 0.205). On Cox proportional hazards regression model, independent factors for overall survival were PBI (hazard ratio 1.38 [95% CI, 1.02-1.87]; p = 0.033), multiple tumors (p = 0.007), tumor size (p = 0.002), and liver cirrhosis (p < 0.001). On the other hand, in the non-B non-C HCC group, both the median overall survival (6.5 years [95% CI, 4.8-7.1]) and recurrence-free survival (2.4 years, [95% CI, 1.5-3.3]) in 104 patients with PBI were not significantly different from those (7.5 years [5.5 − NA; p = 0.932]; and 2.2 years [1.7-2.7; p = 0.983]) in 213 patients without PBI. Conclusions: PBI and HCV in conjunction with each other affect the survival of patients that have undergone resection for HCC.
Annals of Surgery, 2006
The aim of this study is to clarify the difference of risk of recurrence after hepatic resection between patients with hepatitis Band hepatitis C-related hepatocellular carcinoma (HCC). Summary and Background Data: HCC is a highly recurrent carcinoma. However, consensus has not yet been reached about the relationship between hepatitis virus types and risk of recurrence in a longterm follow-up for HCC patients who underwent hepatic resection. Patients and Methods: From the beginning of January 1990 to the end of December 1999, of 469 HCC patients who underwent curative hepatic resection, 66 (14%) patients with positive hepatitis B virus surface antigen (HBs-Ag) and negative hepatitis C virus antibody (HCV-Ab) were regarded to have B-type hepatitis (HB)related HCC (HB-HCC) and 351 (75%) with negative HBs-Ag and positive HCV-Ab were regarded to have C-type hepatitis (HC)related HCC (HC-HCC). A clinical follow-up was performed to assess the existence of recurrence with the median follow-up periods of 11.0 and 10.1 years for HB-and HC-HCC patients, respectively. Results: The 3-, 5-, and 10-year disease-free survival (DFS) rates of HC-HCC (40%, 24%, and 12%, respectively) were significantly shorter than those of HB-HCC (57%, 54%, and 28%, respectively) (P ϭ 0.0001). In multivariate Cox proportional hazard analysis, viral type, TNM stage, surgical margin, and Edmondson's grade were significantly associated with risk of recurrence. The risk of recurrence from the initial HCC increased to 1.93 times (95% confidence interval, 1.27-2.93) greater in HC-HCC patients than in HB-HCC patients. Conclusion: Hepatitis viral type is an independent factor for recurrence of HCC in a long-term clinical follow-up. This finding suggests that we may need a different strategy to control postoperative recurrence by the viral types in HCC patients.
Digestive Surgery, 2001
Hepatocellular carcinoma W Liver resection W Multicentric carcinogenesis W Acute exacerbation of hepatitis W Hepatitis B virus DNA W Hepatitis B envelope antigen W Hepatitis B virus surface antigen W Wild-type hepatitis B virus W Precore mutant-type hepatitis B virus Abstract Background/Aims: During the natural course of hepatitis B virus (HBV) infection, clearance of HB e antigen (HBeAg) and HB surface antigen (HBsAg) occurs with remission of liver disease. We investigated the effects of postoperative changes in virologic and biochemical parameters on the prognosis after liver resection for HBVrelated hepatocellular carcinoma (HCC). Methods: We investigated the relationship between postoperative changes in virologic and biochemical parameters and the incidence of intrahepatic recurrence and the outcome during a 3-year period following surgery in 30 HCC patients with HBsAg. Results: The incidence of intrahepatic recurrence of HCC was significantly higher in patients with acute postoperative exacerbation of hepatitis (p = 0.0084), a sustained high serum concentration of HBV DNA (65.0 mEq/ml, p = 0.001), and sustained expression of HBsAg after surgery (p = 0.0421). A high serum concentration of HBV DNA was significantly associated with a shorter survival time (p = 0.0447) and the cause of death was recurrence of HCC. Conclusion: Patients with acute postoperative exacerbation of hepatitis, sustained HBsAg expression, and sustained high serum concentrations of HBV DNA after surgery may require more intensive postoperative monitoring for HCC recurrence.
PloS one, 2016
Independent risk factors associated with hepatitis B (HBV)-related hepatocellular carcinoma (HCC) after resection remains unknown. An accurate risk score for HCC recurrence is lacking. We prospectively followed up 200 patients who underwent liver resection for HBV-related HCC for at least 2 years. Demographic, biochemical, tumor, virological and anti-viral treatment factors were analyzed to identify independent risk factors associated with recurrence after resection and a risk score for HCC recurrence formulated. Two hundred patients (80% male) who underwent liver resection for HBV-related HCC were recruited. The median time of recurrence was 184 weeks (IQR 52-207 weeks) for the entire cohort and 100 patients (50%) developed HCC recurrence. Stepwise Cox regression analysis identified that one-month post resection HBV DNA >20,000 IU/mL (p = 0.019; relative risk (RR) 1.67; 95% confidence interval (C.I.): 1.09-2.57), the presence of lymphovascular permeation (p<0.001; RR 2.69; 95...
The Medical Journal of Cairo University
Background: Hepatocellular Carcinoma (HCC) is the most common malignancy affecting the liver. It accounts for almost ninety percentage of primary malignancies affecting the liver. HCC develops on a carcinogenic background of liver cirrhosis. Aim of Study: To evaluate our center experience of liver resection for Hepatitis C Virus (HCV) related Hepatocellular Carcinoma (HCC) to determine the predictive factors of early post-operative mortality. Patients and Methods: We reviewed the data for all consecutive patients who underwent liver resection for HCV related HCC during the period between January 2010 and June 2018. Results: Two hundred fourteenconsecutive patients were included in the study. The median age was 59 years (18-78), and median MELD score was 7 (6-16). The median operation time was 170 minutes (70-380) and median blood loss was 680ml (100-5000). The median hospital stay was 5 days (2-60). Post-operative morbidities occurred in 120 patients (56%). Early postoperative mortality occurred in 19 patients (8.9%), all of them developed variable degrees of post-hepatectomy liver dysfunction. The median follow-up duration was 22 months (5-110). Recurrence occurred in 130 patients (60.7%). The 1-, 3-, and 5-years disease-free survival rates were 69.2%, 35.4%, and 17.6%, respectively. Late mortality occurred in 59 patients (27.6%). The 1-, 3-, and 5-years overall survival rates were 78.2%, 59.1%, and 50%, respectively. Predictive factors for early mortalityincluded pre-operative albumin, Child-Pugh score, MELD score, blood loss, severe post-operative morbidities, renal complications, and posthepatectomy liver dysfunction. Conclusion: Proper selection of liver resection candidates based on pre-operative laboratory findings, together with