Liver cirrhosis tied to hepatocellular cancer recurrence

Last Updated: 2017-01-11

By David Douglas

NEW YORK (Reuters Health) - Compared with patients with a normal liver who undergo curative hepatectomy because of de novo hepatocellular carcinoma (HCC), those with liver cirrhosis may have a higher hepatocarcinogenic potential, researchers say.

"In this large dataset of patients with HCC, we clearly defined not only the pattern, but also the annual incidence of recurrence after surgical resection of the tumor," Dr. Timothy M. Pawlik of The Ohio State University, Wexner Medical Center, Columbus, told Reuters Health by email.

"We found that among patients who had HCC arising in a normal liver that the pattern of recurrence was different compared with patients who had an HCC arising in a cirrhotic liver," he said.

The findings were published online January 4 in JAMA Surgery.

Dr. Pawlik and colleagues analyzed data on 424 HCC patients who underwent curative hepatectomy; 73 had normal livers and the remaining 351 had cirrhosis. The researchers then matched 64 patients from each group and compared their outcomes.

At one, three and five years, the cumulative recurrence in the normal group was 17.2%, 23.0% and 37.5%, respectively, versus 25.0%, 55.5%, and 72.1% in the cirrhotic group (p=0.001).

Disease specific survival at five years was 75.4% in the normal group and 59.1% in the cirrhotic group. In addition, the median annual incidence of postoperative recurrence of HCC within five years after surgery was significantly lower in the normal group (5.9% vs. 12.7%, p=0.003).

"In addition," Dr. Pawlik pointed out, "the pattern of recurrence was different with more recurrence near the resection margin or at sites outside the liver among the patient group with cirrhosis."

He added, "The data are important as they demonstrate that de novo recurrence may continuously occur from the early postoperative period until the late period after resection of HCC."

In an accompanying editorial, Dr. David C. Linehan of the University of Rochester Medical Center, New York, and colleagues say the study "provides important information validating recurrence rates and highlights a new pattern of recurrence in noncirrhotic HCC."

However, because the selected patient population was generally younger and had other specific features, "we need to be cautious in extrapolating these data to the entire HCC population," they write.

SOURCE: http://bit.ly/2jiy9tW and http://bit.ly/2juXWy4

JAMA Surg 2017.