Underlying liver disease, not tumor factors, predicts long-term survival alter resection of hepatocellular carcinoma

Hypothesis: A subset of patients can be identified who will survive without recurrence beyond 5 years after hepatic resection for hepatocellular carci noma (HCC). Design: A retrospective review of a multi-institutional database of 591 pat ients who had undergone hepatic resection for HCC and on-site reviews of cl inical records and pathology slides. Setting: All patients had been treated in academic referral centers within university-based hospitals. Patients: We identified 145 patients who had survived for 5 years or longer after hepatic resection for HCC. Main Outcome Measures: Clinical and pathologic factors, as well as scoring of hepatitis and fibrosis in the surrounding liver parenchyma, were assesse d for possible association with survival beyond 5 years and cause of death among the 145 five-year survivors. Results: Median additional survival duration longer than 5 years was 4.1 ye ars. Women had significantly longer median additional survival durations th an did men (81 months vs 38 months, respectively, after the 5-year mark) (P =.008). Surgical margins, type of resection, an elevated preoperative alpha -fetoprotein level, and the presence of multiple tumors or microscopic vas cular invasion had no bearing on survival longer than 5) ears. However, pat ients who survived for 5 years who also had normal underlying liver or mini mal fibrosis (score, 0-2) at surgery had significantly longer additional su rvival than did patients with moderate fibrosis (score, 3-4) or severe fibr osis/cirrhosis (score, 5-6) (P < .001). Conclusions: Death caused by HCC is rare beyond 5) ears after resection of I-ICC in the absence of fibrosis or cirrhosis. The data suggest that chroni c liver disease acts as a field of cancerization contributing to new HCC. T hese patients may benefit from therapies directed at the underlying liver d isease.