Japanese Journal of Clinical Oncology 30:75-81 (2000)
© 2000 Foundation for Promotion of Cancer Research
What Patients Can Survive Disease Free After Complete Resection for Hepatocellular Carcinoma?: A Multivariate Analysis
1First Department of Surgery and 2Department of Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo and 3Biometric Analysis Department, Shionogi & Co., Ltd., Osaka, Japan
Background: Although there have been extensive studies to determine risk factors affecting survival after resection for hepatocellular carcinoma (HCC), we still do not know which patients can survive disease free after curative resection. This study was undertaken to determine independent risk factors affecting the length of disease-free survival.
Methods: 171 patients, who survived disease free more than 1 year after curative resection, were divided into four groups according to the disease-free period: Group I (n = 96) for the patients with intrahepatic recurrence between 1 and 3 postoperative years, Group II(n = 27) for those between 3 and 5 years, Group III (n = 40) for those between 5 and 10 years and Group IV (n = 8) for those without recurrence within 10 years. The 37 variables (host factors, tumor factors, non-tumor liver factors, surgical factors) were compared among the four groups. Activity of hepatitis and hepatic fibrosis was scored by the Histological Activity Index (HAI). In a multivariate study, possible prognostic variables with a statistical difference in the disease-free survival rate among each category were preliminarily selected from the 37 variables and the independent variables were finally selected using a proportional hazard analysis.
Results: The patients’ age, indocyanine green retention rate, microscopic tumor capsular invasion and portal invasion, cell differentiation, extent of hepatectomy, aggressiveness of chronic hepatitis and inflammatory activity assessed by HAI score were significantly different among the four groups. In the multivariate analysis, the following variables were selected as the independent determinants favorable for achieving a longer disease-free period: younger age, lower indocyanine green retention rate, solitary HCC with expansive growth, no microscopic portal invasion and lower activity of co-existing hepatitis.
Conclusions: The importance of inflammatory activity in addition to aging, hepatic reserve and tumor characteristics was confirmed as a risk factor for recurrence by multivariate analysis. To achieve better disease-free survival, not only early detection but also suppression of co-existing hepatitis is necessary.
+ For reprints and all correspondence: Naoki Yamanaka, First Department of Surgery, Hyogo College of Medicine, 1–1, Mukogawa-cho, Nishinomiya, Japan 663-8501Abbreviations: HCC, hepatocellular carcinoma; HAI, histological activity index; ICG R15, indocyanine green retention rate at 15 min; ALB, serum albumin; T-Bil, serum total bilirubin; PT, prothrombin activity; AST, aspartate aminotransaminase; ALT, alanine aminotransaminase; TAE, transarterial embolization; AFP, 
-fetoprotein; Vp, macroscopic portal invasion; IM, macroscopic intrahepatic metastasis; fc, capsule formation; fc-inf, capsule infiltration; sf, septum formation; vp, microscopic portal invasion; im, microscopic intrahepatic metastases; CPH, chronic persistent hepatitis; CAH, chronic aggressive hepatitis; SE, standard error
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