Postoperative prediction of and strategy for metastatic recurrent hepatocellular carcinoma according to histologic activity of hepatitis

BACKGROUND. The hepatitis activity index (PW) score describes the histologi c status of accompanying chronic hepatitis and was established by pathologi sts. The aim of this study was twofold: 1) to investigate the correlation b etween intrahepatic metastatic recurrence (IM) and the HAI score of the non cancerous region of the liver and 2) to estimate the usefulness of postoper ative preventive chemotherapy in patients with hepatocellular carcinoma (HC C). METHODS. The study included 158 consecutive patients who underwent curative resection for HCC and had been observed for >1 year. Based on the HAI scor es of the noncancerous region the patients were classified into 3 groups: t hose with mild hepatitis (n = 33) (i.e., with HAI scores of 0-5), those wit h moderate hepatitis (n = 77) (with HAI scores of 6-9), and those with seve re hepatitis (n = 48) (those with HAI scores of greater than or equal to 10 ). In addition, a prospective randomized trial of postoperative adjuvant ch emotherapy was performed for 21 patients with moderate hepatitis. RESULTS. The patients in the moderate hepatitis group were found to be at h igher risk for IM recurrence within 2 years after HCC resection compared wi th those patients in the mild (P = 0.05) and severe (P < 0.01) hepatitis gr oups. The incidences of more than two tumors and portal vein involvement in patients with moderate hepatitis were much higher than in those patients w ith mild or severe hepatitis. Multivariate analysis showed that intraoperat ive bleeding volume, the number of nodules, portal vein involvement, and mo derate hepatitis were independent predictive factors for IM recurrence free survival. Ten patients with moderate hepatitis had received postoperative intrahepatic arterial chemotherapy (2-3 courses with a maximum dose of 80 m g of cisplatin and 10 mg of mitomycin C at 1-month intervals) for the last 3 years. Although the number of patients was small, the therapy improved th e disease free survival rate significantly compared with 11 patients who re ceived no therapy. CONCLUSIONS. The patients with moderate hepatitis (HAI score of 6-9) had th e highest rate of IM recurrence among the three HAI groups. Postoperative h epatic arterial chemotherapy may be useful in improving the rate of disease free survival after surgery among these patients. Cancer 1999;86:248-54. ( C) 1999 American Cancer Society.