FACTORS AFFECTING LONG-TERM OUTCOME AFTER HEPATIC RESECTION FOR HEPATOCELLULAR-CARCINOMA

BACKGROUND: Experience with hepatocellular carcinoma (HCC) is limited in the West and factors affecting outcome after resection are not clea rly defined. METHODS: Between 1970 and 1999, 106 patients (including 7 4 Caucasians, 31 Orientals, and 1 black) underwent hepatic resection f or HCC at Memorial Sloan-Kettering Cancer Center. Clinical and histopa thologic factors of outcome were analyzed. RESULTS: Cirrhosis was pres ent in 33% and 95% were Child-Pugh A. Operative mortality was 6%, 14% in cirrhotics versus 1% in non-cirrhotics (P = 0.013). Orientals had a higher prevalence of cirrhosis (68% versus 19%) (P <0.0001) and small er tumors (mean 8.7 cm versus 11.0 cm) (P = 0.028) compared to Caucasi ans, Overall survival was 41% and 32% at 5 and 10 years, respectively. By univariate analysis, survival was greater in association with the following: absence of vascular invasion (69% versus 28%, P = 0.002); a bsence of symptoms (66% versus 38%, P = 0.014); solitary tumor (53% ve rsus 28%, P = 0.014); negative margins (46% versus 21%, P = 0.022); sm all tumor (less than or equal to 5 cm) (75% versus 36%, P = 0.027); an d presence of tumor capsule (69% versus 35%, P = 0.047). Ethnic origin , cirrhosis, necrosis and grade did not affect survival. By multivaria te analysis, only vascular invasion predicted outcome (P = 0.0025, ris k ratio 2.9). CONCLUSIONS: One third of patients resected for HCC can be expected to survive long-term. Except for a higher incidence of cir rhosis in Orientals, no major histopathologic or prognostic difference s were noted between Orientals and Caucasians undergoing resection. Ea rly cirrhosis (Child-Pugh A) did not adversely affect survival, Vascul ar invasion predicted long-term outcome.