Prospective case-controlled trial of adjuvant chemotherapy after resectionof hepatocellular carcinoma

Recurrence of hepatocellular carcinoma (HCC) after curative hepatic resecti on is frequent and is an important factor adversely influencing long-term s urvival. The role of postoperative chemotherapy in the reduction of tumor r ecurrence rate is still controversial. During the period of 1992-1995 a ser ies of 49 patients who underwent curative resection of HCC and had at least one risk factor of tumor recurrence were followed in this prospective stud y. Patients were allocated to adjuvant chemotherapy and control groups. Twe nty-four patients received a combination of low dose intravenous epirubicin (20 mg/m(2)) and mitomycin (5 mg) monthly for seven courses starting 5 to 6 weeks after surgery. Twenty-five patients had no adjuvant treatment. The disease-free and overall survivals were compared for the two groups. A tota l of 154 courses of chemotherapy were given to the 24 patients. The chemoth erapy-related side effects were mild and tolerable with no mortality. At a median follow-up of 39 months (range 9-71 months), 9 patients in the adjuva nt chemotherapy group and 16 patients in the control group developed tumor recurrence. The respective 1-, 2-, 3-, and 5-year disease-free survival rat es were 75%, 67%, 63%, and 63% for patients in the adjuvant chemotherapy gr oup and 68%, 42%, 37%, and 32% for patients in the control group (p = 0.057 5). The 1-, 2-, 3-, and 5-year overall survival rates were 100%, 96%, 77%, and 72% in the adjuvant chemotherapy group and 92%, 67%, 63%, and 51% in th e control group (p = 0.0746). In conclusion, postoperative adjuvant chemoth erapy using the present regimen has a tendency to reduce tumor recurrence r ate and may improve long-term survival for high risk patients.