Epidemiology

Survival after hepatoma resection continues to improve

Last Updated: 2011-03-01 13:43:24 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Survival after resection of hepatocellular carcinoma (HCC) has improved significantly over the past 20 years, even in patients with advanced disease, researchers from Hong Kong report.

The data are from 1198 consecutive patients who had HCC resected between 1989 and 2008 at Queen Mary Hospital in Hong Kong.

In the first decade, overall survival rates were 74.8% at 1 year, 54.2% at 3 years, and 42.1% at 5 years. In the second decade, by comparison, survival was 83.3% at 1 year, 64.9% at 3 years, and 54.8% at 5 years (P<.001), said Dr. Sheung Tat Fan and colleagues from The University of Hong Kong.

Recurrence rates were lower in the second decade (60.2%) than in the first (78.2%; P<.001), and disease-free survival rates were higher, the researchers report in Annals of Surgery online February 17th.

Among patients considered transplantable (but not transplanted), 5-year survival increased significantly from 62.7% in the first decade to 72.5% in the second. Disease-free survival in this group rose (nonsignificantly) from 40.2% to 49.2%.

Although disease-free survival in the transplantable patients was "far below" what could be expected after a liver transplant, "prompt treatment of recurrence detected by vigorous postoperative surveillance did result in long-term survival," the authors say.

Given the scarcity of organs for transplant, hepatectomy should be the treatment of choice in patients with resectable HCC and preserved liver function, they add.

Results were also superior in the later period when the analysis was restricted to patients undergoing major hepatectomy for TNM stage III and IV disease.

When the 20 years were divided into four 5-year sequential periods, there was a steady and significant improvement in overall and disease-free survival rates.

And this was "despite (more elderly patients), a higher incidence of comorbid illness, a higher incidence of cirrhosis, and worse liver function" in the second-decade cohort.

"Further improvement of results depends on technical refinement to reduce blood loss to the minimum, avoid blood transfusion, preserve liver remnant function, secure tumor-free resection margins, and meticulous perioperative care to reduce complications," the investigators add.

"Life-long surveillance for recurrence and prompt treatment are mandatory but development of more effective local ablation methods are needed to lengthen postrecurrence survival."

SOURCE: http://bit.ly/haCnDd

Ann Surg 2011.