Vascular Invasion, Satellite Nodules and Absence of Tumor Capsule Strongly Correlate with Disease-Free Survival and Long-Term Outcome in Patients Resected for Hepatocellular Carcinoma

Benedetta Pesi, Luca Moraldi, Daniela Zambonin, Francesco Giudici, Tiziana Cavalli, Rami Addasi, Francesca Leo, Stefano Scaringi, Giacomo Batignani^*

Gastro-Intestinal Surgery Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy.

DOI: 10.4236/jct.2014.514134                

Abstract

Background: Hepatocellular carcinoma (HCC) is one of the most common cancer in the world. Liver resection (LR) is the most used therapy in well compensated liver cirrhosis and maybe used as a first-line treatment. Aim of the study is to evaluate survival rates in patients who underwent LR for HCC and to identify risk factors able to influence the prognosis. Material/Method: A retrospective study was carried out in 115 patients whounderwent LR for HCC. We evaluated overall and disease-free survival rates at 1, 3 and 5years (y) and a series of variables included: type of resection, clamping, blood loss, transfusions, tumor size, presence of capsule, satellite nodules and vascular invasion. Results: The 1-, 3-, 5-y survival rates were 90.2%, 67% and 52.7%, and disease-free survival rates were 75.3%, 44.7% and 28.4%, respectively. We have found presence/ absence of capsulated tumor (p = 0.05), satellite nodules (p = 0.004) and vascular invasion (p = 0.001) as factors able to influence the overall survival and the disease-free survival (p = 0.04 for capsulated tumor, p = 0.01 for satellite nodules and p = 0.006 for vascular invasion). Conclusion: LR is the best therapeutic option for HCC when liver transplantation is contraindicated, with good survival rates. Presence of capsule, satellite nodules and vascular invasion are the most important factors able to influence the prognosis.

Keywords

Liver Resection, Hepatocellular Carcinoma, Prognostic Factors, Vascular Invasion, Satellite Nodules

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Lau, W.Y. (2000) Primary Hepatocellular Carcinoma. In: Blumgart, L.H. and Fong, Y., Eds., Surgery of the Liver and Biliary Tract. W.B. Saunders, England, 1423-1450.
[2]	Belghiti, J. (2008) Surgical Treatment. In: Lau, W.Y., Ed., Hepatocellular Carcinoma. World Scientific Publishing Co. Pte. Ltd., Singapore, 387-408.
[3]	European Association for the Study of the Liver and European Organisation for Research and Treatment of Cancer. (2012) EASL-EORTC Clinical Practice Guidelines: Management of Hepatocellular Carcinoma. Journal of Hepatology, 56, 908-943.
[4]	Cha, C., Fong, Y., Jarnagin, W.R., Blumgart, L.H. and De Matteo, R.P. (2003) Predictors and Patterns of Recurrence after Resection of Hepatocellular Carcinoma. Journal of the American College of Surgeons, 197, 753-758. http://dx.doi.org/10.1016/j.jamcollsurg.2003.07.003
[5]	Belghiti, J., Panis, Y., Farges, O., Benhamou, J.P. and Fekete, F. (1990) Intrahepatic Recurrence after Resection of Hepatocellular Carcinoma Complicating Cirrhosis. Surgery, 214, 114-117.
[6]	Vauthey, J.N., Klimstra, D., Franceschi, D., Tao, Y., Fortner, J., Blumgart, L. and Brennan, M. (1995) Factors Affecting Long-Term Outcome after Hepatic Resection for Hepatocellular Carcinoma. The American Journal of Surgery, 169, 28-35. http://dx.doi.org/10.1016/S0002-9610(99)80106-8
[7]	Ikai, I., Itai, Y., Okita, K., et al. (2004) Report of the 15th Follow-Up Survey of Primary Liver Cancer. Hepatology Research, 28, 21-29. http://dx.doi.org/10.1016/j.hepres.2003.08.002
[8]	Dalla Valle, R., Borie D., Hannoun L. and Botta G.C. (2000) Surgical Treatment of Hepatocellular Carcinoma in Cirrhosis. Digest Liver, 32, 346-352.
[9]	Kawasaki, S., Makuuchi, M., Miyagawa, S., Kakazu, T., Hayashi, K., Kasai, H., Miwa, S., Hui, A.-M. and Nishimaki, K. (1995) Results of Hepatic Resection for Hepatocellular Carcinoma. World Journal of Surgery, 19, 31-34. http://dx.doi.org/10.1007/BF00316976
[10]	Kanematsu, T., Furui, J., Yanaga, K., Okudaira, S., Shimada, M. and Shirabe, K. (2002) A 16 Years Experience in Performing Hepatic Resection in 303 Patients with Hepatocellular Carcinoma: 1985-2000. Surgery, 131, S153-S158. http://dx.doi.org/10.1067/msy.2002.119497
[11]	Grazi, G., Ercolani, G., Pierangeli, F., Del Gaudio, M., Cescon, M., Cavallari, A. and Mazziotti, A. (2001) Improved Results of Liver Resection for Hepatocellular Carcinoma on Cirrhosis Give the Procedure Added Value. Annals of Surgery, 234, 71-78. http://dx.doi.org/10.1097/00000658-200107000-00011
[12]	Matsuda, Y., Ito, T., Oguchi, Y., Nakajima, K. and Izuruka, T. (1992) Rationale of Surgical Management Recurrent Hepatocellular Carcinoma. Surgery, 204, 28-34.
[13]	Torzilli, G., Belghiti, J., Kokudo, N., Takayama, T., Capussotti, L., Nuzzo, G., Vauthey, J.-N., Choti, M.A., De Santibanes, E., Donadon, M., Morenghi, E. and Makuuchi, M. (2013) A Snapshot of the Effective Indications and Results of Surgery for Hepatocellular Carcinoma in Tertiary Referral Centers: Is It Adherent to the EASL/AASLD Recommendations? An Observational Study of the HCC East-West Study Group. Annals of Surgery, 257, 929-937. http://dx.doi.org/10.1097/SLA.0b013e31828329b8
[14]	Ko, S., Nakajima, Y., Kanehiro, H., Kin, T., Aomatsu, Y., Yoshimura, A., Taki, J., Yagura, K., Oashi, K. and Nakano, H. (1996) Influence of Associated Viral Heopatitis Status on Recurrence of Hepatocellular Carcinoma after Hepatectomy. World Journal of Surgery, 20, 1082-1086. http://dx.doi.org/10.1007/s002689900164
[15]	Imamura, H., Matsuyama, Y., Tanaka, E., Okhubo, T., Hasegawa, K., Miyagawa, S., Sugawara, Y., Minagaea, M., Takayama, T., Kawasaki, S. and Makuuchi, M. (2003) Risk Factor Contributing to Early and Late Phase Intrahepatic Recurrence of Hepatocellular Carcinoma after Hepatectomy. Journal of Hepatology, 38, 200-207. http://dx.doi.org/10.1016/S0168-8278(02)00360-4
[16]	Yamazaki, S. and Takayamam, T. (2008) Surgical Treatment of Hepatocellular Carcinoma: Evidence-Based Outcomes. World Journal of Gastroenterology, 14, 685-692. http://dx.doi.org/10.3748/wjg.14.685
[17]	Lee, C.S., Sheu, J.C., Wang, M., et al. (1996) Long-Term Outcome after Surgery for Asymptomatic Small Hepatocellular Carcinoma. British Journal of Surgery, 83, 330-333. http://dx.doi.org/10.1002/bjs.1800830310
[18]	Lai, E.C., Ng, I.O., Ng, M.M., et al. (1990) Long-Term Results of Resection for Large Hepatocellular Carcinoma: A Multivariate Analysis of Clinicopathologic Features. Hepatology, 11, 815-818. http://dx.doi.org/10.1002/hep.1840110516
[19]	Ohkubo, T., Yamamoto, J., Sugawara, Y., Shimada, K., Yamasaki, S., Makuuchi, M. and Kosuge, T. (2000) Surgical Results for Hepatocellular Carcinoma with Macroscopic Portal Vein Tumor Thrombosis. Journal of the American College of Surgeons, 191, 657-660. http://dx.doi.org/10.1016/S1072-7515(00)00740-7
[20]	Kemeny, F., Vadrot, J., Wu, A., et al. (1989) Morphological and Biological Features of Resected Hepatocellular Carcinoma in Cirrhotic Patients in the West. Hepatology, 9, 253-257. http://dx.doi.org/10.1002/hep.1840090215
[21]	Hanazaki, K., Kajikawa, S., Shimozawa, N., Shimada, K., Hiraguri, M., Koide, N., Adaki, W. and Amano, J. (2001) Hepatic Resection for Hepatocellular Carcinoma in the Elderly. Journal of the American College of Surgeons, 192, 138-146.