R. H. Lewis1, D. M. Bittenbinder1, T. O’Brien2, E. S. Glazer1, M. D. Fleming1, S. W. Behrman1, D. Shibata1, J. L. Deneve1, P. V. Dickson1 1University Of Tennessee Health Science Center,Division Of Surgical Oncology, Department Of Surgery,Memphis, TN, USA 2University of Tennessee Health Science Center,Department Of Pathology,Memphis, TN, USA
Introduction:
Hepatocellular Carcinoma (HCC) most commonly arises in the setting of cirrhosis and generally has a poor prognosis. HCC occasionally occurs in non-cirrhotic livers, however, outcomes for these patients are not extensively documented. We report an institutional experience of hepatectomy for HCC in the absence of cirrhosis.
Methods:
We performed of retrospective review of patients with HCC in non-cirrhotic livers who underwent partial hepatectomy. Patients with fibrolamellar tumors and a hepatic fibrosis score >3 were excluded. Clinical data was evaluated to identify factors impacting recurrence free (RFS) and overall survival (OS).
Results:
We identified 40 patients who underwent partial hepatectomy for HCC in the absence of cirrhosis over a 10-year period. Median age was 62 years (23-83) and 65% were male. A solitary tumor was present in 57% with tumor size ranges of 0-4.9cm (25%), 5-9.9cm (40%), and ≥10cm (35%). Non-tumor bearing liver demonstrated hepatic fibrosis scores of F0 in 19 (47.5%), F1 in 12 (30%), F2 in (15%), and F3 in 3 (7.5%) patients. Steatosis was absent in 7 (17.5%), minimal in 31 (77.5%), and moderate in 2 (5%) patients. Hepatitis B and C were documented in 2 and 8 patients, respectively. R0 resection (>1mm margin) was achieved in 32 patients (80%) and major hepatectomy (≥ 3 contiguous segments) was performed in 26 (65%). Overall 30-day post-operative complications occurred in 37.5% and 90-day mortality was 10%. Thirty-five patients had available follow up data, median 28 months (5-125). Among this cohort, 1- and 5-year RFS was 62% and 39% and 1- and 5-year OS was 83% and 53%. For stage I, II, III patients, 5-year RFS and OS were 48%, 34%, 10% (p=0.056) and 60%, 38%, 12% (p=0.025), respectively. On univariate analysis, 5-year RFS and OS were worse for patients with a disrupted/absent vs intact tumor capsule (24% vs 74%, p=0.034; 31% vs 83%, p=0.018); presence of vascular invasion vs none (19% vs 40%, p=0.030; 30% vs 45%, p=0.067), elevated vs normal alkaline phosphatase (Alk Phos) levels (7% vs 49%, p=0.002; 10% vs 55%, p=0.017); and elevated vs normal aspartate aminotransferase (AST) levels (20% vs 50%, p=0.081; 23% vs. 63%, p=0.041). RFS was worse for patients with a tumor size ≥10cm (15%) vs 0-4.9cm (58%) and 5-9.9cm (25%), p=0.042. Alpha fetoprotein levels, viral hepatitis, fibrosis score, hepatic steatosis, higher tumor grade, presence of satellite lesions, and R1 resection did not portend worse RFS or OS in the current study.
Conclusion:
Patients with HCC in the absence of cirrhosis often present with large (>5cm) tumors. Although 5-year OS was 53%, even patients with early stage disease demonstrate high recurrence rates. Disruption or absence of a tumor capsule, tumor size ≥10cm, presence of vascular invasion and elevated Alk Phos and AST were associated with decreased RFS and/or OS. Future analyses of a larger cohort of patients will better define other potential prognostic factors.