The team determined preoperative predictors of survival that can guide the choice of treatment for patients with small hepatocellular cancers (HCCs).
The findings of the trial were published in the May issue of the Annals of Surgery.
Currently, the treatment of patients with small (≤ 5 cm in diameter) HCCs is controversial.
A cohort of 249 patients (69 women, median age 62 years) who underwent resection with curative intent for small HCC was identified from a multiinstitutional database.
For each patient, the clinical data and pathology slides were reviewed.
A total of 6 clinical factors (age, gender, preoperative alpha-fetoprotein level, hepatitis serology, number of tumors [single vs multiple], and Child-Pugh score) and 3 pathologic factors (hepatitis activity score, fibrosis score, and Edmondson-Steiner tumor grade) were assessed before surgery.
All of these factors were correlated with survival.
The researchers found that median overall survival for the entire cohort was 4.2 years.
The estimated overall 5- and 8-year survival rates were 41% and 20%, respectively.
|Predictors of survival after resection:|
- Fibrosis score
- Edmondson-Steiner grade
- Child-Pugh score
| Annals of Surgery |
Multivariate Cox analysis indicated that fibrosis score, Edmondson-Steiner grade, and Child-Pugh score were simultaneously significant predictors of survival after resection.
The team derived a prognostic scoring system based on these covariates and applied it to the entire cohort.
Patients lacking all 3 risk factors were assigned a score of 1, patients with 1 risk factor were assigned a score of 2, and patients with 2 or 3 risk factors were assigned a score of 3.
Pairwise log-rank tests indicated significant differences in survival between scores 1 and 2, scores 2 and 3, and scores 1 and 3.
A subset of 98 patients, with positive hepatitis C serology, was analyzed separately. This scoring system was still found to retain its prognostic significance.
Dr Jeffrey D. Wayne, of the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA, said on behalf of his colleagues, "Patients with small HCCs, who will derive the least benefit from resection, can be identified before surgery.
"This can be done using a score based on tumor grade and the severity of underlying liver disease."
"In these patients, transplantation and/or ablation should be considered as possible alternative therapies,"