Prognostic factors and survival after hepatic resection for hepatocellularcarcinoma without cirrhosis

Background: Detailed follow-up of patients with chronic hepatitis has resul ted in increased diagnosis of hepatocellular carcinoma (HCC) in patients wi thout cirrhosis. Despite numerous studies on hepatic resection, the prognos tic factors for intrahepatic recurrence and survival are not well known for patients with HCC without cirrhosis. Methods: Among 349 patients with HCC treated in the past 13 years, cirrhosi s was absent in 126 patients (36 per cent). Curative hepatic resection was carried out in 100 (79 per cent) of these patients. Risk factors for intrah epatic recurrence and prognostic factors for survival were evaluated by uni variate and multivariate analyses. Results: Postoperative morbidity and mortality rates were 22 and 3 per cent respectively. The 5- and 10-year disease-free and overall survival rates w ere 31 and 50 per cent, and 22 and 47 per cent respectively. Blood loss, su rgical resection margin, intrahepatic metastasis, portal vein invasion and extent of hepatic resection were independently associated with overall surv ival. However, the only risk factors for intrahepatic recurrence were porta l vein invasion and hepatitis C virus (HCV) infection. The former was relat ed to early recurrence while the latter was related to later recurrence. Th e 5-year disease-free survival rate was 58 per cent in patients with hepati tis B virus infection while it was 6 per cent in patients with HCV infectio n (P < 0.001). Conclusion: In the treatment of HCC without cirrhosis, major hepatectomy is advocated to prevent early recurrence. Liver transplantation may be requir ed for patients with HCV infection.