For patients with liver cirrhosis and hepatocellular carcinoma satisfying the Milan criteria, orthotopic liver transplantation is an effective treatment.
Nevertheless, it remains controversial whether orthotopic liver transplantation is the best treatment strategy for patients with resectable hepatocellular carcinoma.
|5-year survival rate was 81% in noncirrhotic patients|
Dr Kojiro Taura and colleagues from Japan studied 293 hepatocellular carcinoma patients, both with and without cirrhosis, who underwent primary and curative liver resection between 1990 and 2003.
The investigative team reported that there were 127 noncirrhotic, 129 Child-Pugh A cirrhotic, and 37 Child-Pugh B cirrhotic patients.
The team found that 5-year survival rates were 81%, 54%, and 28%, in noncirrhotic, Child-Pugh A, and Child-Pugh B cirrhotic patients, respectively.
The team found that coexisting cirrhosis, Child-Pugh classification, and alpha-fetoprotein value were significant prognostic factors.
In addition, tumor burden, and vascular invasion by the tumor were identified as significant prognostic factors.
Among these factors, coexisting cirrhosis was the most crucial variable by multivariate analysis.
The team found during the initial 3 postoperative years, the yearly tumor recurrence rate was 22% in cirrhotic patients, and 15% in noncirrhotic patients.
In cirrhotic patients, the recurrence rate did not decrease even after 3 years of tumor-free survival post-resection.
However, in noncirrhotic patients the recurrence rate decreased to 9%.
Cirrhosis was associated with a higher probability of recurrence exceeding the Milan criteria.
Dr Taura's team concluded, "Hepatic resection offers an acceptable survival result for hepatocellular carcinoma patients fulfilling the Milan criteria."
"Coexisting cirrhosis is associated with higher mortality and recurrence rate, possibly due to multicentric carcinogenesis which limits the efficacy of hepatic resection."