Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 7, 2012; 18(25): 3272-3281
Published online Jul 7, 2012. doi: 10.3748/wjg.v18.i25.3272
Preoperative predictors of short-term survival after hepatectomy for multinodular hepatocellular carcinoma
Wen-Chao Zhao, Hai-Bin Zhang, Ning Yang, Yong Fu, Wei Qian, Ben-Dong Chen, Lu-Feng Fan, Guang-Shun Yang
Wen-Chao Zhao, Hai-Bin Zhang, Ning Yang, Yong Fu, Ben-Dong Chen, Lu-Feng Fan, Guang-Shun Yang, Fifth Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
Wei Qian, Department of Health Statistics, Second Military Medical University, Shanghai 200433, China
Author contributions: Zhao WC and Zhang HB contributed equally to this work; Zhao WC and Zhang HB performed the majority of the research and wrote the paper; Yang N, Fu Y, Fan LF and Chen BD contributed to acquisition of data; Zhao WC and Qian W analyzed the data; Yang GS designed the research and critically revised the draft for important intellectual content; Zhao WC and Zhang HB contributed equally to this work.
Correspondence to: Dr. Guang-Shun Yang, Professor, Fifth Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225 Changhai Road, Shanghai 200438, China. dreamcatcher919@gmail.com
Telephone: +86-21-81875292 Fax: +86-21-81875291
Received: October 14, 2011
Revised: March 21, 2012
Accepted: April 22, 2012
Published online: July 7, 2012
Abstract

AIM: To investigate preoperative factors associated with poor short-term outcome after resection for multinodular hepatocellular carcinoma (HCC) and to assess the contraindication of patients for surgery.

METHODS: We retrospectively analyzed 162 multinodular HCC patients with Child-Pugh A liver function who underwent surgical resection. The prognostic significance of preoperative factors was investigated by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards model. Each independent risk factor was then assigned points to construct a scoring model to evaluate the indication for surgical intervention. A receiver operating characteristics (ROC) curve was constructed to assess the predictive ability of this system.

RESULTS: The median overall survival was 38.3 mo (range: 3-80 mo), while the median disease-free survival was 18.6 mo (range: 1-79 mo). The 1-year mortality was 14%. Independent prognostic risk factors of 1-year death included prealbumin < 170 mg/L [hazard ratio (HR): 5.531, P < 0.001], alkaline phosphatase > 129 U/L (HR: 3.252, P = 0.005), α fetoprotein > 20 μg/L (HR: 7.477, P = 0.011), total tumor size > 8 cm (HR: 10.543; P < 0.001), platelet count < 100 × 109/L (HR: 9.937, P < 0.001), and γ-glutamyl transpeptidase > 64 U/L (HR: 3.791, P < 0.001). The scoring model had a strong ability to predict 1-year survival (area under ROC: 0.925, P < 0.001). Patients with a score ≥ 5 had significantly poorer short-term outcome than those with a score < 5 (1-year mortality: 62% vs 5%, P < 0.001; 1-year recurrence rate: 86% vs 33%, P < 0.001). Patients with score ≥ 5 had greater possibility of microvascular invasion (P < 0.001), poor tumor differentiation (P = 0.003), liver cirrhosis with small nodules (P < 0.001), and intraoperative blood transfusion (P = 0.010).

CONCLUSION: A composite preoperative scoring model can be used as an indication of prognosis of HCC patients after surgical resection. Resection should be considered with caution in patients with a score ≥ 5, which indicates a contraindication for surgery.

Keywords: Hepatectomy, Hepatocellular carcinoma, Multinodular, Prognosis, Treatment outcome