Factors Associated With Recurrence and Survival Following Hepatectomy for Large Hepatocellular Carcinoma: A Multicenter Analysis

Background: Optimal management of large (>5 cm) hepatocellular carcinoma (HCC) remains controversial. We sought to determine the factors associated with recurrence and survival for patients with large HCC following hepatectomy. Methods: An analysis of a combined prospective database front two tertiary care centers was performed on consecutive patients who underwent hepatectomy for HCC >5 cm. Univariate and multivariate analyses were performed to determine factors associated with recurrence, disease-free (DFS) and overall survival (OS). Results: Seventy-eight patients were identified: 32 (41%) had hepatic fibrosis. Forty-six patients (59%) underwent a major hepatectomy with a morbidity rate of 41% and a mortality rate of 13%. Fibrosis was associated with male gender (P = 0.045), hepatitis C (P = 0.003), higher Child-Pugh (P < 0.0001) and Okuda score (P = 0.002), smaller tumors (6.25 cut vs. 10.5 cm; P < 0.001), positive-margin resection (P = 0.01) and death (P = 0.047). Factors associated with recurrence include tumor multifocality (P = 0.03) and vascular invasion (P = 0.02). Predictors of OS include multifocal tumors (P=0.05) margin status (P=0.02), vascular invasion (P=0.01), and treatment complications (P=0.004). The median overall DFS and OS were 12 and 20 months, respectively. Fibrosis had no impact on DFS (P = 0.24) or OS (P = 0.20). Conclusions: For patients with HCC larger than 5 cm, tumor-related factors predict outcomes and survival. J. Surg. Oncol. 2010;101:105-110. (C) 2009 Wiley-Liss, Inc.