Annals of Surgical Oncology

, Volume 10, Issue 8, pp 916–921 | Cite as

Predictors of Long-Term Disease-Free Survival After Resection of Hepatocellular Carcinoma: Two Decades of Experience at Chang Gung Memorial Hospital

  • Chun-Nan YehEmail author
  • Wei-Chen Lee
  • Miin-Fu Chen
  • Pei-Kwei Tsay
Original Articles


Background: Hepatocellular carcinoma (HCC) is a common disease in Taiwan. A high incidence of recurrence after hepatectomy is the most important cause of unsatisfactory results after resection of HCC. This study aimed to determine the clinicopathologic factors for predicting survival >5 years without recurrence in HCC patients treated with hepatectomy.

Methods: The clinical features of 46 patients with surgically resected HCC who survived >5 years without recurrence (group A) were reviewed. Also, comparison was made with the clinical features and factors influencing the outcome of 1046 cases of resected HCC who survived <5 years both with and without recurrence and for >5 years with recurrence (group B).

Results: Of 1092 cases of surgically resected HCC, 46 (4.5%) survived >5 years without recurrence. Univariate analysis revealed that absence of vascular invasion, satellite lesions, low histological grading of HCC, a lower rate of underlying liver cirrhosis, wider resection margins, and an uneventful postoperative course were frequent in group A patients compared with group B patients. Moreover, multivariate stepwise logistic regression analysis identified an absence of satellite lesions and an uneventful postoperative course as the two main independently significant predictors of HCC patients undergoing hepatectomy with long-term disease-free survival. The 1-, 3-, 5-, and 10-year survival rates of group A patients were 100%, 100%, 100%, and 84.1%, whereas those of group B patients were 73.5%, 47.9%, 29.0%, and 21.2%, respectively.

Conclusions: An absence of satellite lesions and an uneventful postoperative course are the two main independent predictors for long-term disease-free survival in HCC patients undergoing hepatic resection.

Key Words

Predictors Long-term disease-free survival Hepatic resection Hepatocellular carcinoma 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Department of Health, Executive Yuan, Republic of China. Annual Report of Cancer Registration. 2001.Google Scholar
  2. 2.
    Iwatsuki S, Starzl TE, Sheahan DG, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg 1991;214:221–8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ringe B, Pichlmayr R, Wittekind C, Tusch G. Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. World J Surg 1991;15:270–85.CrossRefPubMedGoogle Scholar
  4. 4.
    Lai EC, Fan ST, Lo CM, Chu KM, Liu CL, Wong J. Hepatic resection for hepatocellular carcinoma. An audit of 343 patients. Ann Surg 1995;221:291–8.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Lee WC, Jeng LB, Chen MF. Hepatectomy for hepatitis B-, hepatitis C-, and dual hepatitis B- and C-related hepatocellular carcinoma in Taiwan. J Hepatobiliary Pancreat Surg 2000;7:265–9.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lee PH, Lin WJ, Tsang YM, et al. Clinical management of recurrent hepatocellular carcinoma. Ann Surg 1995;222:670–6.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kubo S, Kinoshita H, Hirohashi K, et al. Patterns and risk factors for recurrence after liver resection for well-differentiated hepatocellular carcinoma: a special reference to multicentric carcinogenesis after operation. Hepatogastroenterology 1999;46:3212–5.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Poon RTP, Fan ST, Lo VM, Liu CL, Wong J. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 1999;229:216–22.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Chen MF, Hwang TL, Jeng LB, Wang CS, Jan YY, Chen SC. Postoperative recurrence of hepatocellular carcinoma. Two hundred five consecutive patients who underwent hepatic resection in 15 years. Arch Surg 1994;129:738–42.CrossRefPubMedGoogle Scholar
  10. 10.
    Poon RTP, Fan ST, Wong J. Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg 2000;232:10–24.CrossRefGoogle Scholar
  11. 11.
    Lee WC, Jeng LB, Chen MF. Estimation of prognosis after hepatectomy for hepatocellular carcinoma. Br J Surg 2002;89:311–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Tsai HP, Lee WC, Long JB, Chen MF. Clinicopathologic factors influencing long term survival after resection for hepatocellular carcinoma. Chang Gung Med J 2000;23:529–35.PubMedGoogle Scholar
  13. 13.
    Shirabe K, Shimada M, Kajiyama K, et al. Clinicopathologic features of patients with hepatocellular carcinoma surviving > 10 years after hepatic resection. Cancer 1998;83:2312–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Healy JE, Schroy PC. Anatomy of the biliary ducts within the human liver: analysis of the prevailing pattern of branching and the major variations of the biliary ducts. Arch Surg 1953;66:599–616.CrossRefGoogle Scholar
  15. 15.
    Couinaud C. Le Foie: Etudes Anatomiques et Chirurgicales. Paris: Masson Publishers, 1957:187–208.Google Scholar
  16. 16.
    Kasai Y, Tamaki A, Kakita H, et al. Surgical treatment of primary hepatocellular carcinoma. Geka Shinryo 1977;19:46–54.Google Scholar
  17. 17.
    Nagasue N, Uchida M, Makino Y, et al. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology 1993;105:488–94.CrossRefPubMedGoogle Scholar
  18. 18.
    Yamamoto J, Kosuge T, Takayama T, et al. Recurrence of hepatocellular carcinoma after surgery. Br J Surg 1996;83:1219–22.CrossRefPubMedGoogle Scholar
  19. 19.
    Sasaki Y, Imaoka S, Matsutani S, et al. Influence of coexisting cirrhosis on long-term prognosis after surgery in patients with hepatocellular carcinoma. Surgery 1992;112:515–21.PubMedGoogle Scholar
  20. 20.
    Ikeda K, Saitoh S, Tsubota A, et al. Risk factors for tumor recurrence and prognosis after curative resection of hepatocellular carcinoma. Cancer 1993;71:19–25.CrossRefPubMedGoogle Scholar
  21. 21.
    Adachi E, Maeda T, Kajiyama K, et al. Factors correlated with portal venous invasion by hepatocellular carcinoma: univariate and multivariate analyses of 232 resected cases without preoperative treatments. Cancer 1996;77:2022–31.CrossRefPubMedGoogle Scholar
  22. 22.
    Shirabe K, Matsumata T, Adachi E, et al. Prognosis of well differentiated small hepatocellular carcinoma—is well-differentiated hepatocellular carcinoma clinically early cancer? Hepatogastroenterology 1995;42:923–30.PubMedGoogle Scholar
  23. 23.
    Chen MF, Hwang TL, Jeng LB, et al. Postoperative recurrence of hepatocellular carcinoma. Two hundred five consecutive patients who underwent hepatic resection in 15 years. Arch Surg 1994;129:738–42.CrossRefPubMedGoogle Scholar
  24. 24.
    Nonami T, Harada A, Kurokawa T, et al. Hepatic resection for hepatocellular carcinoma. Am J Surg 1997;173:288–91.CrossRefPubMedGoogle Scholar
  25. 25.
    Chen MF, Lee WC, Jeng LB. Surgical results in patients with hepatitis virus-related hepatocellular carcinoma in Taiwan. World J Surg 2002;26:742–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Mansour A, Watson W, Shayani V, Pickelman J. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery 1997;122:730–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Aranha GC, Sontag SJ, Greenle HB. Cholecystectomy in cirrhotic patients. A formidable operation. Am J Surg 1983;143:306–9.Google Scholar
  28. 28.
    Cuschieri A, Dubois F, Mouiel J, et al. The European experience with laparoscopic cholecystectomy. Am J Surg 1991;161:385–7.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2003

Authors and Affiliations

  • Chun-Nan Yeh
    • 1
    • 3
    Email author
  • Wei-Chen Lee
    • 1
  • Miin-Fu Chen
    • 1
  • Pei-Kwei Tsay
    • 2
  1. 1.Department of General SurgeryChang Gung Memorial Hospital, Chang Gung UniversityTaoyuanTaiwan
  2. 2.Department of Public Health and Center of BiostatisticsChang Gung UniversityTaoyuanTaiwan
  3. 3.Department of General SurgeryChang Gung Memorial HospitalKwei-ShanTaiwan

Personalised recommendations