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Multivariate and univariate analysis of prognostic factors following resection in HCC: the Birmingham experience
Abraham R John1, Saboor Khan, Darius F Mirza
1Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Insights
This study on hepatocellular carcinoma (HCC) resection in the UK found recurrence and histological grade significantly impact survival. Preoperative assessment using MELD scores is recommended for cirrhotics.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Liver Transplantation
Background:
- Experience with hepatocellular carcinoma (HCC) resection in a UK tertiary Hepatobiliary and Liver Transplant Unit.
- Analysis of surgical outcomes for HCC in a Western healthcare setting.
Purpose of the Study:
- To evaluate the outcomes of hepatic resection for HCC.
- To identify factors influencing long-term survival and recurrence after HCC resection.
- To compare HCC treatment strategies in Western versus Eastern settings.
Main Methods:
- Retrospective analysis of a prospective database.
- Inclusion of 715 HCC cases, with 100 undergoing hepatic resection and 159 liver transplant.
- Statistical analysis of survival and recurrence rates, including multivariate analysis.
Main Results:
- 1-, 3-, and 5-year survival rates post-resection were 75.3%, 37.0%, and 21.5% respectively.
- Significant factors for survival included resection margin, recurrence, alpha-fetoprotein, and albumin.
- Recurrence rates at 1 and 3 years were 27.3% and 72.5%, influenced by histological grade, AFP, gender, and portal vein involvement.
Conclusions:
- HCC resection data from Eastern centers may not directly apply to Western centers due to higher transplant rates.
- Liver function tests and imaging are adequate for pre-resection assessment; MELD score is valuable for cirrhotics.
- Patients with HCC and cirrhosis require evaluation by a transplant unit before treatment.
Background:
The aim of this study was to look into our experience of resection for hepatocellular carcinomas (HCCs) in a tertiary Hepatobiliary and Liver Transplant Unit in the UK.
Methods:
A retrospective analysis of our prospective database was carried out.
Results:
715 cases of HCC were seen. 100 (13.9%) underwent hepatic resection and 159 (22.2%) orthotopic liver transplant. The 1-, 3- and 5-year overall survival following resection was 75.3, 37.0 and 21.5% respectively. Factors affecting long-term survival included resection margin (p < 0.001), recurrence (p < 0.007), alpha-fetoprotein >50 (p < 0.001) and serum albumin (p < 0.03). On multivariate analysis, recurrence (p < 0.001) and histological grade (p < 0.044) were significant. The 1- and 3-year recurrence rates were 27.3 and 72.5% respectively. Histological grade (p < 0.007), alpha-fetoprotein >50 (p < 0.033), female gender (p < 0.016) and portal vein involvement (p < 0.016) were significant in recurrence.
Conclusions:
Resection data from the East may not be comparable to the West owing to the higher transplant activity in the latter. Liver function tests and imaging would be sufficient to assess liver function prior to hepatic resection. HCC with cirrhosis should be assessed by a transplant unit prior to any treatment. The MELD (Model for End-Stage Liver Disease) score would be a valuable preoperative tool in the assessment of cirrhotics.
