LONG-TERM PROGNOSIS AFTER HEPATECTOMY FOR HEPATOCELLULAR-CARCINOMA - A SURVIVAL ANALYSIS OF 204 CONSECUTIVE PATIENTS

BACKGROUND. Intrahepatic recurrence continues to be the main cause of late death among hepatocellular carcinoma patients after hepatic resec tion. The aims of the current study were to identify the prognostic fa ctors affecting long term survival and to evaluate the clinical value of pTNM classification as a prognostic factor for these patients. The identification of significant prognostic factors plays an important ro le in the selection of patients for postoperative adjuvant therapy and counseling. METHODS. From January 1989 to August 1995, 204 consecutiv e patients underwent hepatectomy for hepatocellular carcinoma. The ove rall cumulative and disease free survival rates for these patients wer e analyzed. Univariate and multivariate analyses of 16 clinicopatholog ic factors, including factors associated with pTNM classification, wer e performed to determine the significant prognostic factors. RESULTS. The median periods of overall cumulative survival and disease free sur vival were 35 months and 12.4 months, respectively. By univariate anal ysis, all factors associated with tumor (T) classification, namely, tu mor size, vascular invasion, the number of tumor nodules, and tumor lo calization, were correlated with survival. By Cox regression analysis, preoperative indocyanine green retention value at 15 minutes, tumor s ize, and number of tumor nodules were independent prognostic factors o f long term survival, whereas the number of tumor nodules, tumor size, and venous permeation were the most powerful predictors of tumor recu rrence. The cumulative 5-year survival rates for patients with Stages I, II, III, and IVA tumors were 72%, 55%, 34%, and 8%, respectively. S ignificant differences in cumulative survival curves were observed amo ng the categories of pTNM classification. CONCLUSIONS, The results of this study showed that pTNM classification correlated well with postop erative survival. Preoperative evaluation of hepatic functional reserv e with an indocyanine green clearance test plays an important role in determining the long term prognoses of patients with hepatocellular ca rcinoma. (C) 1998 American Cancer Society.