Surgery
Surgery
5 years ago

Liver resection for recurrent hepatocellular carcinoma to improve survivability: a proposal of indication criteria

Despite curative resection of hepatocellular carcinoma, patients have a high probability of recurrence. We examined indications for liver resection in cases of recurrent hepatocellular carcinoma. Methods Patients undergoing a second liver resection (n = 210) or treatment by transcatheter arterial chemoembolization (n = 184) for recurrent hepatocellular carcinoma of up to 3 lesions were included. We developed a prediction score based on prognostic factors and compared survival according to this prediction score. Results The prediction score was based on 3 independent variables identified by survival analysis in 210 patients undergoing a second liver resection and included age ≥ 75 years, tumor size ≥ 3.0 cm, and multiple tumors. Each patient was assigned a total score. Median overall survival in patients undergoing a second liver resection with scores of 0, 1, and 2/3 were 7.9 years (95% confidence interval, 5.6 − NA), 4.5 years (3.8 − 6.2), and 2.6 years (2.1 − 5.3), respectively (P < 0.001). Among patients with a score of 0, the survival in patients undergoing liver resection was greater than survival in those undergoing transcatheter arterial chemoembolization (median 7.9 [95% confidence interval, 5.6 − NA] years versus 3.1 [2.1 − 3.7] years, P < 0.001), and resection was an independent factor for survival. In contrast, survival did not differ in patients with scores 2/3 (2.6 years [95% confidence interval, 1.9 − 5.3] versus 2.3 years [1.6 − 2.8], P = 0.176). Conclusion Liver resection is recommended as first-line therapy for recurrent hepatocellular carcinoma in patients with a score of 0, while those with score 2/3 should be considered candidates for transcatheter arterial chemoembolization.

Publisher URL: www.sciencedirect.com/science

DOI: S003960601730925X

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