Effectiveness of hepatic resection for early-stage hepatocellular carcinoma in cirrhotic patients: Subgroup analysis according to Milan criteria

Background: The aim of this study was to determine the long-term post-resection outcomes for cirrhotic patients with early-stage hepatocellular carcinoma (HCC). Methods: A total of 217 <= 65-year-old cirrhotic patients who underwent hepatic resection were divided into four groups in accordance with the Milan criteria: Group 1, those who met the Milan criteria (n = 130); Group 2A, those with a solitary tumor >5 cm in size (n = 12); Group 2B, those with 2 or 3 tumors >3 cm in size (n = 35); and Group 2C, those with >= 4 tumors (n = 33). Overall and recurrence-free survival were compared between the groups. Results: At 1, 3, 5 and 10 years, overall survival rates were 91, 67, 45 and 12%, and recurrence-free survival rates were 62, 26, 16 and 0%, respectively. Independent prognostic factors for overall survival were age, blood transfusion, tumor number, tumor size and microscopic vascular invasion; and for recurrence they were hepatitis C infection, tumor number, tumor size, microscopic vascular invasion and histological tumor grade. Group 1 patients had significantly better survival (5-year survival rate, 56%) than those of other groups (5-year survival rate, around 30%). The median tumor-free survival time was significantly shorter in Groups 2B and 2C (0.7 years and 0.6 years, respectively) than in Groups 1 and 2A. Conclusions: Hepatic resection can confer a considerable overall survival benefit for cirrhotic patients with HCC who meet the Milan criteria. For patients with HCC who do not meet the criteria, however, hepatic resection has limited efficacy. We suggest that application of non-surgical therapy or expansion of the indications for liver transplantation may be warranted for such patient subsets.