Ann Surg Treat Res.  2018 Mar;94(3):129-134. 10.4174/astr.2018.94.3.129.

Early disseminated recurrence after liver resection in solitary hepatocellular carcinoma

• Kim JM
• Yi NJ
• Kwon CH
• Lee KW
• Suh KS
• Joh JW

• KMID: 2405324
• DOI: http://doi.org/10.4174/astr.2018.94.3.129

Abstract

PURPOSE
Although few hepatectomy patients develop unexpected early diffuse and multinodular recurrence in the remnant liver, the prognosis in such cases is often dismal. The aim of this study was to evaluate the risk factors of early disseminated multinodular hepatocellular carcinoma (HCC) recurrence within 3 months after liver resection for solitary HCC.
METHODS
Eighty-four patients who were diagnosed with recurrent HCC within 3 months after hepatectomy for solitary HCC were retrospectively reviewed. Disseminated HCC recurrence was defined as more than 10 tumors in both lobes and total tumor size >10 cm.
RESULTS
Preoperative α-FP level, incidence of poor tumor grade, and presence of portal vein tumor thrombosis were higher in the patients with disseminated HCC recurrence than in those without disseminated HCC recurrence (P < 0.05). Multivariate analysis showed that α-FP >1,000 ng/dL was a predisposing factor of disseminated HCC recurrence within 3 months after liver resection. The overall survival rate for patients without disseminated HCC recurrence was higher than that for patients with disseminated HCC recurrence (P < 0.001).
CONCLUSION
Early disseminated multinodular HCC recurrence in hepatectomy patients was associated with preoperative α-FP >1,000 ng/dL. Such patients should be frequently evaluated for the early detection of recurrent HCC for early intervention.

Keyword

Hepatocellular carcinoma; Hepatectomy; Recurrence; Tumor biomarker; Survival

MeSH Terms

Carcinoma, Hepatocellular*
Causality
Early Intervention (Education)
Hepatectomy
Humans
Incidence
Liver*
Multivariate Analysis
Portal Vein
Prognosis
Recurrence*
Retrospective Studies
Risk Factors
Survival Rate
Thrombosis

Figure

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  Fig. 1 Overall survival after liver resection. HCC, hepatocellular carcinoma.

Reference

1. Cherqui D, Laurent A, Mocellin N, Tayar C, Luciani A, Van Nhieu JT, et al. Liver resection for transplantable hepatocellular carcinoma: long-term survival and role of secondary liver transplantation. Ann Surg. 2009; 250:738–746.

2. Lee HY, Rhim H, Lee MW, Kim YS, Choi D, Park MJ, et al. Early diffuse recurrence of hepatocellular carcinoma after percutaneous radiofrequency ablation: analysis of risk factors. Eur Radiol. 2013; 23:190–197.

3. Kim JM, Kwon CH, Joh JW, Park JB, Lee JH, Kim SJ, et al. Outcomes after curative hepatectomy in patients with non-B non-C hepatocellular carcinoma and hepatitis B virus hepatocellular carcinoma from non-cirrhotic liver. J Surg Oncol. 2014; 110:976–981.

4. Kim JM, Kwon CH, Joh JW, Park JB, Lee JH, Kim SJ, et al. Differences between hepatocellular carcinoma and hepatitis B virus infection in patients with and without cirrhosis. Ann Surg Oncol. 2014; 21:458–465.

5. Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, et al. Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol. 2003; 38:200–207.

6. Kim BW, Kim YB, Wang HJ, Kim MW. Risk factors for immediate post-operative fatal recurrence after curative resection of hepatocellular carcinoma. World J Gastroenterol. 2006; 12:99–104.

7. Kamiyama T, Nakanishi K, Yokoo H, Kamachi H, Tahara M, Kakisaka T, et al. Analysis of the risk factors for early death due to disease recurrence or progression within 1 year after hepatectomy in patients with hepatocellular carcinoma. World J Surg Oncol. 2012; 10:107.

8. Kim JM, Kwon CH, Joh JW, Park JB, Ko JS, Lee JH, et al. The effect of alkaline phosphatase and intrahepatic metastases in large hepatocellular carcinoma. World J Surg Oncol. 2013; 11:40.

9. Kim JM, Kwon CH, Joh JW, Ko JS, Park JB, Lee JH, et al. C-reactive protein may be a prognostic factor in hepatocellular carcinoma with malignant portal vein invasion. World J Surg Oncol. 2013; 11:92.

10. Kim JM, Hyuck C, Kwon D, Joh JW, Lee JH, Paik SW, et al. Protein induced by vitamin K antagonist-II (PIVKA-II) is a reliable prognostic factor in small hepatocellular carcinoma. World J Surg. 2013; 37:1371–1378.

11. Yu SJ. A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010–2016. Clin Mol Hepatol. 2016; 22:7–17.

12. Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer. 1954; 7:462–503.

13. Song KD, Lim HK, Rhim H, Lee MW, Kim YS, Lee WJ, et al. Repeated hepatic resection versus radiofrequency ablation for recurrent hepatocellular carcinoma after hepatic resection: a propensity score matching study. Radiology. 2015; 275:599–608.

14. Lee S, Hyuck David Kwon C, Man Kim J, Joh JW, Woon Paik S, Kim BW, et al. Time of hepatocellular carcinoma recurrence after liver resection and alpha-fetoprotein are important prognostic factors for salvage liver transplantation. Liver Transpl. 2014; 20:1057–1063.

15. Park JH, Koh KC, Choi MS, Lee JH, Yoo BC, Paik SW, et al. Analysis of risk factors associated with early multinodular recurrences after hepatic resection for hepatocellular carcinoma. Am J Surg. 2006; 192:29–33.

16. Picardo A, Karpoff HM, Ng B, Lee J, Brennan MF, Fong Y. Partial hepatectomy accelerates local tumor growth: potential roles of local cytokine activation. Surgery. 1998; 124:57–64.

17. Fuks D, Dokmak S, Paradis V, Diouf M, Durand F, Belghiti J. Benefit of initial resection of hepatocellular carcinoma followed by transplantation in case of recurrence: an intention-to-treat analysis. Hepatology. 2012; 55:132–140.