Author(s): Vauthey JN, Klimstra D, Franceschi D, Tao Y, Fortner J,
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Abstract BACKGROUND: Experience with hepatocellular carcinoma (HCC) is limited in the West and factors affecting outcome after resection are not clearly defined. METHODS: Between 1970 and 1992, 106 patients (including 74 Caucasians, 31 Orientals, and 1 black) underwent hepatic resection for HCC at Memorial Sloan-Kettering Cancer Center. Clinical and histopathologic factors of outcome were analyzed. RESULTS: Cirrhosis was present in 33\% and 95\% were Child-Pugh A. Operative mortality was 6\%, 14\% in cirrhotics versus 1\% in non-cirrhotics (P = 0.013). Orientals had a higher prevalence of cirrhosis (68\% versus 19\%) (P < 0.0001) and smaller tumors (mean 8.7 cm versus 11.0 cm) (P = 0.028) compared to Caucasians. Overall survival was 41\% and 32\% at 5 and 10 years, respectively. By univariate analysis, survival was greater in association with the following: absence of vascular invasion (69\% versus 28\%, P = 0.002); absence of symptoms (66\% versus 38\%, P = 0.014); solitary tumor (53\% versus 28\%, P = 0.014); negative margins (46\% versus 21\%, P = 0.022); small tumor (< or = 5 cm) (75\% versus 36\%, P = 0.027); and presence of tumor capsule (69\% versus 35\%, P = 0.047). Ethnic origin, cirrhosis, necrosis and grade did not affect survival. By multivariate analysis, only vascular invasion predicted outcome (P = 0.0025, risk ratio 2.9). CONCLUSIONS: One third of patients resected for HCC can be expected to survive long-term. Except for a higher incidence of cirrhosis in Orientals, no major histopathologic or prognostic differences were noted between Orientals and Caucasians undergoing resection. Early cirrhosis (Child-Pugh A) did not adversely affect survival. Vascular invasion predicted long-term outcome.
This article was published in Am J Surg
and referenced in Journal of Liver