Clinicopathological characteristics of patients with extrahepatic recurrence following a hepatectomy for hepatocellular carcinoma

Background/Aims: None of the previous studies have compared the prognosis o r clinicopathological factors between the patients with extrahepatic recurr ence and those with intrahepatic recurrence of hepatocellular carcinoma aft er a hepatic resection. Methodology: The clinicopathological features and prognoses of patients wit h extrahepatic recurrence after a curative hepatectomy for hepatocellular c arcinoma were investigated. Results: Twenty-three patients with extrahepatic recurrence had more advanc ed-stage hepatocellular carcinoma at the primary operation compared to 186 patients with intrahepatic recurrence. After adjusting for tumor size, the prognosis of the 2 groups were comparable. However, among the patients with hepatocellular carcinoma exceeding 5cm in diameter, the number of patients whose plasma levels of des-gamma -carboxy prothrombin was higher than 2.0 AU/mL in the patients with extra-hepatic recurrence (62.5%) was significant ly more (P <0.05) than that in the patients with intrahepatic recurrence (2 0.0%). On the other hand, the prognosis of the 13 patients with extrahepati c recurrence alone was significantly better than in the 10 patients with bo th intrahepatic and extrahepatic recurrences. The prognoses of the 3 patien ts who underwent a surgical resection for isolated extrahepatic recurrence were markedly better than that of the remaining 10 patients only treated pa lliatively. Conclusions: If patients have tumors exceeding 5cm. in diameter and their p lasma levels of des-gamma -carboxy prothrombin are higher than 2.0 AU/mL, m ore careful follow-up examinations than usual may thus be necessary in orde r to detect extrahepatic recurrence as early as possible. Furthermore, a su rgical resection for the isolated extrahepatic recurrence of hepatocellular carcinoma is also recommended to produce long-term survivors.