Richard H Lewis1, Evan S Glazer1,2, David M Bittenbinder1, Thomas O'Brien3, Jeremiah L Deneve1,2, David Shibata1,2, Stephen W Behrman1, Jason M Vanatta4, Sanjaya K Satapathy5, Paxton V Dickson6,7. 1. Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA. 2. West Cancer Center, Memphis, TN, USA. 3. Memphis Pathology Group, 1211 Union Avenue, Suite 300, Memphis, TN, 38104, USA. 4. Transplant Center, Cleveland Clinic Florida-Weston, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA. 5. Methodist University Transplant Institute, Sherard Wing, First Floor, 1265 Union Ave., Memphis, TN, 38104, USA. 6. Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, 3rd Floor, Memphis, TN, 38163, USA. pdickso1@uthsc.edu. 7. West Cancer Center, Memphis, TN, USA. pdickso1@uthsc.edu.
Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) occasionally occurs in non-cirrhotic patients; however, outcomes for these patients are not extensively documented. METHODS: We performed an institutional review of patients without cirrhosis who underwent resection for HCC. Clinical data were evaluated to identify factors impacting recurrence-free survival (RFS) and overall survival (OS). RESULTS: Forty-two patients underwent hepatectomy for HCC in the absence of cirrhosis over a 10-year period. Median follow-up was 22 months. For the entire cohort, 1-, 3-, and 5-year RFS was 62%, 42%, and 38% and 1-, 3-, and 5-year OS was 78%, 60%, and 49%, respectively. On univariate analysis, RFS was significantly worse for patients with a disrupted/absent tumor capsule (p = 0.027), vascular invasion (p = 0.030), elevated alkaline phosphatase (p = 0.004), and tumor size > 10 cm (p = 0.016). OS was significantly worse for patients with a disrupted/absent tumor capsule (p = 0.044), obesity (p = 0.036), and elevated alkaline phosphatase (p = 0.007) with a trend towards decreased OS for tumor size > 10 cm (p = 0.07). CONCLUSIONS: Patients undergoing resection for HCC in the absence of cirrhosis have fairly high recurrence and modest survival rates. Pre-operative alkaline phosphatase, tumor size, tumor encapsulation, and vascular invasion are important prognostic factors.
BACKGROUND:Hepatocellular carcinoma (HCC) occasionally occurs in non-cirrhotic patients; however, outcomes for these patients are not extensively documented. METHODS: We performed an institutional review of patients without cirrhosis who underwent resection for HCC. Clinical data were evaluated to identify factors impacting recurrence-free survival (RFS) and overall survival (OS). RESULTS: Forty-two patients underwent hepatectomy for HCC in the absence of cirrhosis over a 10-year period. Median follow-up was 22 months. For the entire cohort, 1-, 3-, and 5-year RFS was 62%, 42%, and 38% and 1-, 3-, and 5-year OS was 78%, 60%, and 49%, respectively. On univariate analysis, RFS was significantly worse for patients with a disrupted/absent tumor capsule (p = 0.027), vascular invasion (p = 0.030), elevated alkaline phosphatase (p = 0.004), and tumor size > 10 cm (p = 0.016). OS was significantly worse for patients with a disrupted/absent tumor capsule (p = 0.044), obesity (p = 0.036), and elevated alkaline phosphatase (p = 0.007) with a trend towards decreased OS for tumor size > 10 cm (p = 0.07). CONCLUSIONS:Patients undergoing resection for HCC in the absence of cirrhosis have fairly high recurrence and modest survival rates. Pre-operative alkaline phosphatase, tumor size, tumor encapsulation, and vascular invasion are important prognostic factors.
Entities:
Keywords:
Hepatocellular carcinoma; Non-cirrhotic; Surgery
Authors: A el-Refaie; K Savage; S Bhattacharya; S Khakoo; T J Harrison; M el-Batanony; S Nasr; N Mokhtar; K Amer; P J Scheuer; A P Dhillon Journal: J Hepatol Date: 1996-03 Impact factor: 25.083
Authors: Eric Dupont-Bierre; Philippe Compagnon; Jean-Luc Raoul; Gabriel Fayet; Anne-Sophie de Lajarte-Thirouard; Karim Boudjema Journal: J Am Coll Surg Date: 2005-09-30 Impact factor: 6.113
Authors: Hynek Mergental; Rene Adam; Bo-Goran Ericzon; Piotr Kalicinski; Ferninand Mühlbacher; Krister Höckerstedt; Jürgen L Klempnauer; Styrbjörn Friman; Christoph E Broelsch; Georges Mantion; Carlos Fernandez-Sellez; Bart van Hoek; Josef Fangmann; Jacques Pirenne; Paolo Muiesan; Alfred Königsrainer; Darius F Mirza; Jan Lerut; Olivier Detry; Yves-Ptrice Le Treut; Vincenzo Mazzaferro; Florian Löhe; Marina Berenguer; Pierre-Alain Clavien; Xavier Rogiers; Jacques Belghiti; Laslo Kóbori; Patrizia Burra; Philippe Wolf; Wolfgang Schareck; Przemyslaw Pisarski; Aksel Foss; Franco Filipponi; Marek Krawczyk; Martin Wolff; Jan M Langrehr; Keith Rolles; Neville Jamieson; Wim C J Hop; Robert J Porte Journal: J Hepatol Date: 2012-04-18 Impact factor: 25.083
Authors: Wladimir Faber; Siamak Sharafi; Martin Stockmann; Timm Denecke; Bruno Sinn; Gero Puhl; Marcus Bahra; Maciej B Malinowski; Peter Neuhaus; Daniel Seehofer Journal: Surgery Date: 2012-11-01 Impact factor: 3.982
Authors: S Truant; E Boleslawski; A Duhamel; A-F Bouras; A Louvet; C Febvay; E Leteurtre; G Huet; P Zerbib; S Dharancy; M Hebbar; F-R Pruvot Journal: Eur J Surg Oncol Date: 2012-08-03 Impact factor: 4.424