Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma

Jean Nicolas Vauthey, David Klimstra, Dido Franceschi, Yue Tao, Joseph Fortner, Leslie Blumgart, Murray Brennan

Research output: Contribution to journalArticle

279 Citations (Scopus)

Abstract

Background: Experience with hepatocellular carcinoma (HCC) is limited in the West and factors affecting outcome after resection are not clearly defined. Methods: Between 1970 and 1992, 106 patients (including 74 Caucasians, 31 Orientals, and 1 black) underwent hepatic resection for HCC at Memorial Sloan-Kettering Cancer Center. Clinical and histopathologic factors of outcome were analyzed. Results: Cirrhosis was present in 33% and 95% were Child-Pugh A. Operative mortality was 6%, 14% in cirrhotics versus 1% in noncirrhotics (P = 0.013). Orientals had a higher prevalence of cirrhosis (68% versus 19%) (P <0.0001) and smaller tumors (mean 8.7 cm versus 11.0 cm) (P = 0.028) compared to Caucasians. Overall survival was 41% and 32% at 5 and 10 years, respectively. By univariate analysis, survival was greater in association with the following: absence of vascular invasion (69% versus 28%, P = 0.002); absence of symptoms (66% versus 38%, P = 0.014); solitary tumor (53% versus 28%, P = 0.014); negative margins (46% versus 21%, P = 0.022); small tumor (≤5 cm) (75% versus 36%, P = 0.027); and presence of tumor capsule (69% versus 35%, P = 0.047). Ethnic origin, cirrhosis, necrosis and grade did not affect survival. By multivariate analysis, only vascular invasion predicted outcome (P = 0.0025, risk ratio 2.9). Conclusions: One third of patients resected for HCC can be expected to survive long-term. Except for a higher incidence of cirrhosis in Orientals, no major histopathologic or prognostic differences were noted between Orientals and Caucasians undergoing resection. Early cirrhosis (Child-Pugh A) did not adversely affect survival. Vascular invasion predicted long-term outcome.

Original languageEnglish
Pages (from-to)28-35
Number of pages8
JournalThe American Journal of Surgery
Volume169
Issue number1
DOIs
StatePublished - Jan 1 1995
Externally publishedYes

Fingerprint

Hepatocellular Carcinoma
Fibrosis
Liver
Blood Vessels
Survival
Neoplasms
Capsules
Necrosis
Multivariate Analysis
Odds Ratio
Mortality
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma. / Vauthey, Jean Nicolas; Klimstra, David; Franceschi, Dido; Tao, Yue; Fortner, Joseph; Blumgart, Leslie; Brennan, Murray.

In: The American Journal of Surgery, Vol. 169, No. 1, 01.01.1995, p. 28-35.

Research output: Contribution to journalArticle

Vauthey, Jean Nicolas ; Klimstra, David ; Franceschi, Dido ; Tao, Yue ; Fortner, Joseph ; Blumgart, Leslie ; Brennan, Murray. / Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma. In: The American Journal of Surgery. 1995 ; Vol. 169, No. 1. pp. 28-35.
@article{aa8b70fd037f4f55ba730b56f5e39824,
title = "Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma",
abstract = "Background: Experience with hepatocellular carcinoma (HCC) is limited in the West and factors affecting outcome after resection are not clearly defined. Methods: Between 1970 and 1992, 106 patients (including 74 Caucasians, 31 Orientals, and 1 black) underwent hepatic resection for HCC at Memorial Sloan-Kettering Cancer Center. Clinical and histopathologic factors of outcome were analyzed. Results: Cirrhosis was present in 33{\%} and 95{\%} were Child-Pugh A. Operative mortality was 6{\%}, 14{\%} in cirrhotics versus 1{\%} in noncirrhotics (P = 0.013). Orientals had a higher prevalence of cirrhosis (68{\%} versus 19{\%}) (P <0.0001) and smaller tumors (mean 8.7 cm versus 11.0 cm) (P = 0.028) compared to Caucasians. Overall survival was 41{\%} and 32{\%} at 5 and 10 years, respectively. By univariate analysis, survival was greater in association with the following: absence of vascular invasion (69{\%} versus 28{\%}, P = 0.002); absence of symptoms (66{\%} versus 38{\%}, P = 0.014); solitary tumor (53{\%} versus 28{\%}, P = 0.014); negative margins (46{\%} versus 21{\%}, P = 0.022); small tumor (≤5 cm) (75{\%} versus 36{\%}, P = 0.027); and presence of tumor capsule (69{\%} versus 35{\%}, P = 0.047). Ethnic origin, cirrhosis, necrosis and grade did not affect survival. By multivariate analysis, only vascular invasion predicted outcome (P = 0.0025, risk ratio 2.9). Conclusions: One third of patients resected for HCC can be expected to survive long-term. Except for a higher incidence of cirrhosis in Orientals, no major histopathologic or prognostic differences were noted between Orientals and Caucasians undergoing resection. Early cirrhosis (Child-Pugh A) did not adversely affect survival. Vascular invasion predicted long-term outcome.",
author = "Vauthey, {Jean Nicolas} and David Klimstra and Dido Franceschi and Yue Tao and Joseph Fortner and Leslie Blumgart and Murray Brennan",
year = "1995",
month = "1",
day = "1",
doi = "10.1016/S0002-9610(99)80106-8",
language = "English",
volume = "169",
pages = "28--35",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma

AU - Vauthey, Jean Nicolas

AU - Klimstra, David

AU - Franceschi, Dido

AU - Tao, Yue

AU - Fortner, Joseph

AU - Blumgart, Leslie

AU - Brennan, Murray

PY - 1995/1/1

Y1 - 1995/1/1

N2 - Background: Experience with hepatocellular carcinoma (HCC) is limited in the West and factors affecting outcome after resection are not clearly defined. Methods: Between 1970 and 1992, 106 patients (including 74 Caucasians, 31 Orientals, and 1 black) underwent hepatic resection for HCC at Memorial Sloan-Kettering Cancer Center. Clinical and histopathologic factors of outcome were analyzed. Results: Cirrhosis was present in 33% and 95% were Child-Pugh A. Operative mortality was 6%, 14% in cirrhotics versus 1% in noncirrhotics (P = 0.013). Orientals had a higher prevalence of cirrhosis (68% versus 19%) (P <0.0001) and smaller tumors (mean 8.7 cm versus 11.0 cm) (P = 0.028) compared to Caucasians. Overall survival was 41% and 32% at 5 and 10 years, respectively. By univariate analysis, survival was greater in association with the following: absence of vascular invasion (69% versus 28%, P = 0.002); absence of symptoms (66% versus 38%, P = 0.014); solitary tumor (53% versus 28%, P = 0.014); negative margins (46% versus 21%, P = 0.022); small tumor (≤5 cm) (75% versus 36%, P = 0.027); and presence of tumor capsule (69% versus 35%, P = 0.047). Ethnic origin, cirrhosis, necrosis and grade did not affect survival. By multivariate analysis, only vascular invasion predicted outcome (P = 0.0025, risk ratio 2.9). Conclusions: One third of patients resected for HCC can be expected to survive long-term. Except for a higher incidence of cirrhosis in Orientals, no major histopathologic or prognostic differences were noted between Orientals and Caucasians undergoing resection. Early cirrhosis (Child-Pugh A) did not adversely affect survival. Vascular invasion predicted long-term outcome.

AB - Background: Experience with hepatocellular carcinoma (HCC) is limited in the West and factors affecting outcome after resection are not clearly defined. Methods: Between 1970 and 1992, 106 patients (including 74 Caucasians, 31 Orientals, and 1 black) underwent hepatic resection for HCC at Memorial Sloan-Kettering Cancer Center. Clinical and histopathologic factors of outcome were analyzed. Results: Cirrhosis was present in 33% and 95% were Child-Pugh A. Operative mortality was 6%, 14% in cirrhotics versus 1% in noncirrhotics (P = 0.013). Orientals had a higher prevalence of cirrhosis (68% versus 19%) (P <0.0001) and smaller tumors (mean 8.7 cm versus 11.0 cm) (P = 0.028) compared to Caucasians. Overall survival was 41% and 32% at 5 and 10 years, respectively. By univariate analysis, survival was greater in association with the following: absence of vascular invasion (69% versus 28%, P = 0.002); absence of symptoms (66% versus 38%, P = 0.014); solitary tumor (53% versus 28%, P = 0.014); negative margins (46% versus 21%, P = 0.022); small tumor (≤5 cm) (75% versus 36%, P = 0.027); and presence of tumor capsule (69% versus 35%, P = 0.047). Ethnic origin, cirrhosis, necrosis and grade did not affect survival. By multivariate analysis, only vascular invasion predicted outcome (P = 0.0025, risk ratio 2.9). Conclusions: One third of patients resected for HCC can be expected to survive long-term. Except for a higher incidence of cirrhosis in Orientals, no major histopathologic or prognostic differences were noted between Orientals and Caucasians undergoing resection. Early cirrhosis (Child-Pugh A) did not adversely affect survival. Vascular invasion predicted long-term outcome.

UR - http://www.scopus.com/inward/record.url?scp=0028851163&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028851163&partnerID=8YFLogxK

U2 - 10.1016/S0002-9610(99)80106-8

DO - 10.1016/S0002-9610(99)80106-8

M3 - Article

C2 - 7817995

AN - SCOPUS:0028851163

VL - 169

SP - 28

EP - 35

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

IS - 1

ER -