Risk factors for early death due to recurrence after resection of large hepatocellular carcinomas

Long-term survival after resection of hepatocellular carcinomas larger than 5 cm in diameter is worse than after resection of smaller tumors. The risk factors for early death due to recurrence after resection of large tumors have not been clearly elucidated.

Among 377 patients who underwent curative resection of hepatocellular carcinoma between 1992 and 2004, 115 patients with tumors larger than 5 cm in diameter were enrolled. They were divided into two groups, i.e., 35 patients who died of recurrent cancer within 2 years after surgery and 80 patients who survived for more than 2 years.

The preoperative serum alpha-fetoprotein level, positive surgical margins, number of tumors, the serum levels of albumin and alpha-fetoprotein at 1 and 3 months after surgery, as well as the prothrombin time, cholinesterase and protein induced by vitamin K antagonism-II levels at 3 months, respectively, were significant determinants of survival by univariate analysis. Multivariate analysis showed that an albumin level <3.5 g/dl at 1 month and a cholinesterase level <100 U/L at 3 months after surgery were associated with an increased risk of early death due to recurrence.

The hepatic functional reserve in the early postoperative period significantly influences early recurrence and early death after resection of large hepatocellular carcinomas. It is important to maintain a good perioperative nutritional status and early postoperative adjuvant therapy is required for patients with large tumors.