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Article: Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma

TitleCritical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma
Authors
Issue Date2005
PublisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.com
Citation
Archives Of Surgery, 2005, v. 140 n. 5, p. 450-458 How to Cite?
AbstractHypothesis: A subset of patients with hepatocellular carcinoma (HCC) with a diameter of 10 cm or larger may benefit from hepatic resection. Design: Retrospective study of a multi-institutional database. Setting: Five major hepatobiliary centers. Patients: We identified 300 patients who underwent hepatic resection for HCC 10 cm or larger. Main Outcome Measures: Clinical and pathologic data were collected, and prognostic factors were evaluated by univariate and multivariate analyses. Patient survival was stratified according to a clinical scoring system and pathologic T classification. Results: The perioperative mortality rate was 5%. At a median follow-up of 32 months, the median survival was 20.3 months, and the 5-year actuarial survival rate was 27%. Four clinical factors-α-fetoprotein of 1000 ng/mL or higher, multiple tumor nodules, the presence of major vascular invasion, and the presence of severe fibrosis-were significant predictors of poor survival (all P<.05). Patients were assigned a clinical score according to the following risk factors: 1, no factor; 2, one or two factors; or 3, three or four factors. On the basis of the clinical score, patients could be stratified into only 2 distinct prognostic groups: no factor (score of 1) vs 1 or more factors (score of 2 or 3) (P<.001). In contrast, when patients were stratified according to pathologic T classification, 3 distinct groups were identified: T1 vs T2 vs T3 and T4 combined (P<.001). Fifty-six percent of the patients with a clinical score of 2 and 20% of patients with a clinical score of 3 actually had T1 or T2 disease on pathologic examination. Conclusions: Patients with large HCCs should be considered for liver resection as this treatment is associated with a 5-year survival rate exceeding 25%. Clinical predictors should not be used to exclude patients from surgical resection because these factors do not reliably predict outcome.
Persistent Identifierhttp://hdl.handle.net/10722/88774
ISSN
2014 Impact Factor: 4.926
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorPawlik, TMen_HK
dc.contributor.authorPoon, RTen_HK
dc.contributor.authorAbdalla, EKen_HK
dc.contributor.authorZorzi, Den_HK
dc.contributor.authorIkai, Ien_HK
dc.contributor.authorCurley, SAen_HK
dc.contributor.authorNagorney, DMen_HK
dc.contributor.authorBelghiti, Jen_HK
dc.contributor.authorOiLin Ng, Ien_HK
dc.contributor.authorYamaoka, Yen_HK
dc.contributor.authorLauwers, GYen_HK
dc.contributor.authorVauthey, JNen_HK
dc.contributor.authorBrems, Jen_HK
dc.contributor.authorRidee, Ben_HK
dc.contributor.authorHelton, Sen_HK
dc.contributor.authorBilchik, Aen_HK
dc.contributor.authorChapman, Wen_HK
dc.date.accessioned2010-09-06T09:47:48Z-
dc.date.available2010-09-06T09:47:48Z-
dc.date.issued2005en_HK
dc.identifier.citationArchives Of Surgery, 2005, v. 140 n. 5, p. 450-458en_HK
dc.identifier.issn0004-0010en_HK
dc.identifier.urihttp://hdl.handle.net/10722/88774-
dc.description.abstractHypothesis: A subset of patients with hepatocellular carcinoma (HCC) with a diameter of 10 cm or larger may benefit from hepatic resection. Design: Retrospective study of a multi-institutional database. Setting: Five major hepatobiliary centers. Patients: We identified 300 patients who underwent hepatic resection for HCC 10 cm or larger. Main Outcome Measures: Clinical and pathologic data were collected, and prognostic factors were evaluated by univariate and multivariate analyses. Patient survival was stratified according to a clinical scoring system and pathologic T classification. Results: The perioperative mortality rate was 5%. At a median follow-up of 32 months, the median survival was 20.3 months, and the 5-year actuarial survival rate was 27%. Four clinical factors-α-fetoprotein of 1000 ng/mL or higher, multiple tumor nodules, the presence of major vascular invasion, and the presence of severe fibrosis-were significant predictors of poor survival (all P<.05). Patients were assigned a clinical score according to the following risk factors: 1, no factor; 2, one or two factors; or 3, three or four factors. On the basis of the clinical score, patients could be stratified into only 2 distinct prognostic groups: no factor (score of 1) vs 1 or more factors (score of 2 or 3) (P<.001). In contrast, when patients were stratified according to pathologic T classification, 3 distinct groups were identified: T1 vs T2 vs T3 and T4 combined (P<.001). Fifty-six percent of the patients with a clinical score of 2 and 20% of patients with a clinical score of 3 actually had T1 or T2 disease on pathologic examination. Conclusions: Patients with large HCCs should be considered for liver resection as this treatment is associated with a 5-year survival rate exceeding 25%. Clinical predictors should not be used to exclude patients from surgical resection because these factors do not reliably predict outcome.en_HK
dc.languageengen_HK
dc.publisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.comen_HK
dc.relation.ispartofArchives of Surgeryen_HK
dc.subject.meshActuarial Analysisen_HK
dc.subject.meshCarcinoma, Hepatocellular - mortality - surgeryen_HK
dc.subject.meshDatabases, Factualen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshFollow-Up Studiesen_HK
dc.subject.meshHepatectomyen_HK
dc.subject.meshHumansen_HK
dc.subject.meshLiver - pathologyen_HK
dc.subject.meshLiver Neoplasms - mortality - surgeryen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshPrognosisen_HK
dc.subject.meshRetrospective Studiesen_HK
dc.subject.meshRisk Factorsen_HK
dc.subject.meshSurvival Rateen_HK
dc.subject.meshTime Factorsen_HK
dc.subject.meshalpha-Fetoproteins - analysisen_HK
dc.titleCritical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinomaen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0004-0010&volume=140&issue=5&spage=450&epage=457&date=2005&atitle=Critical+appraisal+of+the+clinical+and+pathologic+predictors+of+survival+after+resection+of+large+hepatocellular+carcinomaen_HK
dc.identifier.emailPoon, RT: poontp@hkucc.hku.hken_HK
dc.identifier.emailOiLin Ng, I: iolng@hkucc.hku.hken_HK
dc.identifier.authorityPoon, RT=rp00446en_HK
dc.identifier.authorityOiLin Ng, I=rp00335en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1001/archsurg.140.5.450en_HK
dc.identifier.pmid15897440-
dc.identifier.scopuseid_2-s2.0-20944432143en_HK
dc.identifier.hkuros99725en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-20944432143&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume140en_HK
dc.identifier.issue5en_HK
dc.identifier.spage450en_HK
dc.identifier.epage458en_HK
dc.identifier.isiWOS:000228839600007-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridPawlik, TM=7006249269en_HK
dc.identifier.scopusauthoridPoon, RT=7103097223en_HK
dc.identifier.scopusauthoridAbdalla, EK=7006112354en_HK
dc.identifier.scopusauthoridZorzi, D=8394976400en_HK
dc.identifier.scopusauthoridIkai, I=7006764463en_HK
dc.identifier.scopusauthoridCurley, SA=7006597814en_HK
dc.identifier.scopusauthoridNagorney, DM=35400419300en_HK
dc.identifier.scopusauthoridBelghiti, J=35403099400en_HK
dc.identifier.scopusauthoridOiLin Ng, I=7102753722en_HK
dc.identifier.scopusauthoridYamaoka, Y=7201994050en_HK
dc.identifier.scopusauthoridLauwers, GY=35391239300en_HK
dc.identifier.scopusauthoridVauthey, JN=35270590000en_HK
dc.identifier.scopusauthoridBrems, J=7006399126en_HK
dc.identifier.scopusauthoridRidee, B=8394977500en_HK
dc.identifier.scopusauthoridHelton, S=6603638012en_HK
dc.identifier.scopusauthoridBilchik, A=7004799381en_HK
dc.identifier.scopusauthoridChapman, W=7203062191en_HK

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