Impaired liver function and long-term prognosis after hepatectomy for hepatocellular carcinoma.

Patients with hepatocellular carcinoma (HCC) show a wide variety of histologic changes in the noncancerous liver parenchyma, and these changes may affect the prognosis. In this study, we grouped patients according to the extent of liver impairment and investigated their long-term prognosis after hepatectomy for HCC. A total of 194 patients were divided into two groups according to their plasma clearance rate of indocyanine green (ICG-K) values: those with values < 0.13 min-1 (group A, n = 97) and those with values of > or = 0.13 min-1 (group B, n = 97). Eighty-nine patients with stage I or II HCC were also divided into two groups: those with values < 0.13 min-1 (group C, n = 52) and those with values of > or = 0.13 min-1 (group D, n = 37). Group B patients tended to survive longer than group A patients during 4 years after hepatectomy, and group D patients survived significantly longer than group C patients (p < 0.01). There was no significant difference in the recurrence-free survival rates between those in groups A and B or groups C and D. Because patients with poor liver function frequently had multiple recurrent lesions and limited therapeutic options, patients with good liver function received more intensive treatment. In conclusion, the extent of liver impairment is one of the factors determining long-term prognosis after hepatectomy for HCC, especially during the early stage of the disease.