Liver resection for single large hepatocellular carcinoma: a prognostic factors study

Introduction and objectives: Liver resection is the only curative therapeutic option for large hepatocellular car-cinoma (> 5 cm), but survival is worse than in smaller tumours, mostly due to the high recurrence rate. There is currently no proper tool for stratifying relapse risk. Herein, we investigated prognostic factors before hepa-tectomy in patients with a single large hepatocellular carcinoma (HCC).Material and methods: We retrospectively identified 119 patients who underwent liver resection for a single large HCC in 2 tertiary academic French centres and collected pre-and post-operative clinical, biological and radiological features. The primary outcome was overall survival at five years. Secondary outcomes were recurrence-free survival at five years and prognostic factors for recurrence.Results: A total of 84% of the patients were male, and the median age was 66 years old (IQR 58-74). Thirty-nine (33%) had Child-Pugh A cirrhosis, and the mean Model for End-Stage Liver Disease (MELD) score was 6 (6-6). The aetiology of liver disease was predominantly alcohol-related (48%), followed by nonalcoholic stea-tohepatitis (22%), hepatitis B (18%) and hepatitis C (10%). The mean tumour size was 70 mm (55-110). The median overall survival was 72.5 months (IC 95%: 56.2-88.7), and the five-year overall survival was 55.1 +/- 5.5%. The median recurrence-free survival was 26.6 months (95% CI: 16.0-37.1), and the five-year recur-rence-free survival rate was 37.8 +/- 5%. In multivariate analysis, preoperative prognostic factors for recur-rence were baseline alpha-fetoprotein (AFP) > 7 ng/mL (p<0.001), portal veinous invasion (p=0.003) and cirrhosis (p=0.020). Using these factors, we created a simple recurrence-risk scoring system that classified three groups with distinct disease-free survival medians (p<0.001): no risk factors (65 months), 1 risk factor (36 months), and >= 2 risk factors (8.9 months).Conclusion: Liver resection is the only curative option for large HCC, and we confirmed that survival could be acceptable in experienced centres. Recurrence is the primary issue of surgery, and we proposed a simple pre-operative score to help identify patients with the most worrisome prognosis and possible candidates for combined therapy.(c) 2022 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Automated summary

Liver resection is the only curative option for large hepatocellular carcinoma, but the survival rate is lower due to high recurrence. There is currently no proper tool for stratifying relapse risk. In this study, we investigated prognostic factors before liver resection in patients with a single large hepatocellular carcinoma.