T. Gocho1, Y. Saito1, M. Tsunematsu1, R. Maruguchi1, R. Iwase1, J. Yasuda1, F. Suzuki1, S. Onda1, T. Hata1, S. Wakiyama1, Y. Ishida1, K. Yanaga1 1Jikei University School Of Medicine,Department Of Surgery,Minato-ku, TOKYO, Japan
Introduction: Standard treatment strategy for intrahepatic recurrence (IHR) of hepatocellular carcinoma (HCC) within Milan criteria (MC) after primary hepatic resection is different between Western countries and Japan. In Western countries, salvage liver transplantation (ST) is reported to have good results, while repeat hepatectomy in Japan is usually a treatment of choice for patients with good hepatic reserves in Japan. The aim of this study is to evaluate the prognostic impact of IHR of HCC within MC and to identify factors related to IHR within MC.
Methods: Between April 2003 and December 2015, 218 patients were treated with primary resection for HCC at Jikei University Hospital. Of those, 118 patients who developed IHR were retrospectively reviewed, and the significance of the following clinicopathological factors were assessed: patient factors (age, sex, viral status, background liver), primary and recurrent tumor factors (size, number, macroscopic portal vein invasion), treatment modality and 5-year overall survival after recurrence (5-y OS).
Results: Median age was 68 years (29 – 90) and 107 patients (91%) were male. Sixty-eight patients (58%) developed IHR within MC, and 37 patients (54%) were treated with repeat hepatectomy. With the median follow-up period of 64.6 months, IHR within MC showed significantly better 5-y OS (74%) as compared with IHR beyond MC (22%) (p < 0.001?. 5-y OS of the patients with IHR within MC treated with repeat hepatectomy was 85%, which was better than reported 5-y OS of ST. By univariate analysis, the patients with IHR within MC had higher rate of HBV+?p = 0.034?, tumor size more than 5 cm ?p < 0.001? and macroscopic PV invasion ?p = 0.041?. By multivariate analysis, independent prognostic factors consisted of tumor size more than 5 cm ?p = 0.041?, macroscopic PV invasion (p = 0.027? and repeat hepatectomy ?p < 0.001?.
Conclusion: IHR within MC after primary liver resection in selected patients for HCC could be treated with repeat hepatectomy with good outcome as compared with ST.