Abstract：
BACKGROUND:Despite curative resection of hepatocellular carcinoma, patients have a high probability of recurrence. We examined indications for liver resection in cases of recurrent hepatocellular carcinoma. METHODS:Patients undergoing a second liver resection (n=210) or treatment by transcatheter arterial chemoembolization (n=184) for recurrent hepatocellular carcinoma of up to 3 lesions were included. We developed a prediction score based on prognostic factors and compared survival according to this prediction score. RESULTS:The prediction score was based on 3 independent variables identified by survival analysis in 210 patients undergoing a second liver resection and included age ≥ 75 years, tumor size ≥ 3.0 cm, and multiple tumors. Each patient was assigned a total score. Median overall survival in patients undergoing a second liver resection with scores of 0, 1, and 2/3 were 7.9 years (95% confidence interval, 5.6-NA), 4.5 years (3.8-6.2), and 2.6 years (2.1-5.3), respectively (P < 0.001). Among patients with a score of 0, the survival in patients undergoing liver resection was greater than survival in those undergoing transcatheter arterial chemoembolization (median 7.9 [95% confidence interval, 5.6-NA] years versus 3.1 [2.1-3.7] years, P < 0.001), and resection was an independent factor for survival. In contrast, survival did not differ in patients with scores 2/3 (2.6 years [95% confidence interval, 1.9-5.3] versus 2.3 years [1.6-2.8], P = 0.176). CONCLUSION:Liver resection is recommended as first-line therapy for recurrent hepatocellular carcinoma in patients with a score of 0, while those with score 2/3 should be considered candidates for transcatheter arterial chemoembolization.
journal_name
Surgeryjournal_title
Surgeryauthors
Yagi R,Midorikawa Y,Moriguchi M,Nakayama H,Aramaki O,Yamazaki S,Higaki T,Takayama Tdoi
10.1016/j.surg.2017.12.022subject
Has Abstractpub_date
2018-06-01 00:00:00pages
1250-1256issue
6eissn
0039-6060issn
1532-7361pii
S0039-6060(17)30925-Xjournal_volume
163pub_type
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