Prognostic factors after liver resection for hepatocellular carcinoma with hepatitis B virus-related cirrhosis: The surgeon's role in survival

Aims: Little is known in judging significant factors that affect the outcome of hepatocellular carcinoma (HCC) patients with hepatitis B virus (HBV)-related cirrhosis undergoing liver resection. The aim of the present study is to investigate the controllable and uncontrollable poor prognostic factors for hepatectomy in patients with HBV-related cirrhosis. Methods: Clinical and pathological data of 412 HCC patients with HBV-related cirrhosis undergoing liver resection from October 1996 to October 2006 were retrospectively reviewed and the prognostic risk factors were analyzed by univariate and multivariate analyses. Cumulative survival was calculated with respect to the number of prognostic risk factors. Results: The significant risk factors for decreasing both the overall and disease-free Survival of patients were: (1) ascites volume of more than 500 ml; (2) prothrombin time of more than 4 s; (3) serum AFP of more than 400 ng/ml; (4) tumor distribution in two lobes; (5) vascular invasion; (6) capsule absence; and (7) blood transfusion of more than 600 ml. Moreover, female gender and operation time of more than 5 h are risk factors of tumor recurrence but not for the patients' overall survival. The 3-year survival rate decreased from 100% to 0 as the number of risk factors in the patients increased from zero to four or more. Patients who had two or more preoperative risk factors were poor candidates for liver resection, with a 3-year survival rate of 8.5%. Conclusions: The survival of HCC patients with HBV-related cirrhosis after liver resection depends on preoperative liver reserve, tumor status and blood transfusion. Tumor status cannot be altered; however, the surgeon can do a great favor to the prognosis of patients by mininnizing bleeding and blood transfusion. Patients with two or more preoperative risk factors should be cautiously selected for liver resection. (C) 2008 Elsevier Ltd. All rights reserved.