Improving survival results after resection of hepatocellular carcinoma: A prospective study of 377 patients over 10 years

Objective To investigate whether the survival results after resection of hepatocellul ar carcinoma (HCC) have improved within the past decade by an analysis of a prospective cohort of patients over a 10-year period. Summary Background Data The surgical death rate after resection of HCC has greatly improved in rece nt years, but the long-term prognosis remains unsatisfactory. It remains un known whether the survival results after resection of HCC have improved wit hin the past decade. Methods The clinicopathologic and follow-up data of 377 patients who underwent cura tive resection of HCC between January 1989 and January 1999 were prospectiv ely collected. These patients were categorized according to two time period s: before 1994 (group 1, n = 136) and after 1994 (group 2, n = 241). The tw o groups were compared for clinicopathologic data and survival results. The prognostic factors for disease-free survival were further analyzed to iden tify the factors that might have led to improved survival outcomes. Results The overall and disease-free survival results were significantly better iii group 2 compared with group 1. Patients in group 2 had significantly highe r proportions of subclinical presentation, small tumors, and tumors of earl y pTNM stage. There were also significantly lower frequencies of histologic margin involvement, less intraoperative blood loss, and a lower transfusio n rate in group 2. By multivariate analysis, early pTNM stage, subclinical HCC, and no perioperative transfusion were independent favorable prognostic factors for disease-free survival. Conclusions Significant improvement of overall and disease-free survival results after resection oi HCC has been achieved within the past decade as a result of ad vances in the diagnosis and surgical management of HCC, Earlier diagnosis o f HCC by better imaging modalities, increased detection of subclinical HCC by screening of high-risk patients, and a reduced perioperative transfusion rate were identified as the major contributory factors for the improved ou tcomes.