Journal List > Korean J Hepatobiliary Pancreat Surg > v.16(3) > 1040576

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Byeon, Cho, Kim, and Choi: Extrahepatic recurrence of hepatocellular carcinoma after curative hepatic resection
Original Article
Korean Journal of Hepato-Biliary-Pancreatic Surgery

Korean Journal of Hepato-Biliary-Pancreatic Surgery 2012; 16(3): 93-97.

Published online: 31 August 2012

DOI: https://doi.org/10.0000/kjhbps.2012.16.3.93

Extrahepatic recurrence of hepatocellular carcinoma after curative hepatic resection

Jangmoo Byeon1, Eung-Ho Cho1, Sang Bum Kim1, Dong Wook Choi2

1Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea.

2Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author: Eung-Ho Cho. Department of Surgery, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul 139-706, Korea. Tel: +82-2-970-1218, Fax: +82-2-970-2419, gsceho@gmail.com

Received 28 June 2012       Revised 25 July 2012       Accepted 27 July 2012

Copyright © 2012 Korean Association of HBP Surgery

Abstract

Backgrounds/Aims

This study was designed to compare the recurrence patterns after curative hepatectomy, to compare the prognosis according to the initial site of metastasis, and to investigate the independent predictive factors associated with extrahepatic recurrence in hepatocellular carcinoma (HCC) patients after curative hepatectomy.

Methods

From January 2000 to July 2009, 307 patients underwent curative hepatectomies for HCC at our institution; 152 patients showed recurrences. Patients were divided into 2 groups according to their initial recurrence site: the intrahepatic recurrence (IHR) group and extrahepatic recurrence (EHR) group. The IHR group was comprised of 111 patients and the EHR group was comprised of 41 patients. The study investigated the preoperative, intraoperative, and postoperative factors related to the recurrence pattern retrospectively and compared the prognoses of the patients.

Results

A five-year survival rate after an initial recurrence was lower in the EHR group (21.5%) than the IHR group (36.3%) (p<0.001). The preoperative alpha-fetoprotein (AFP) level was an independent risk factor for extrahepatic recurrence (p=0.014).

Conclusions

Patients with a preoperative AFP level greater than 200 ng/ml have a higher incidence of extrahepatic metastases after a curative resection of HCC. Increased level of preoperative AFP is an indication for a short-term follow up hepatectomy.

Keywords: Hepatocellular carcinoma, Hepatectomy, Recurrence

Figures and Tables

Fig. 1
Comparison of survival rates between intrahepatic recurrence (IHR) and extrahepatic recurrence (EHR) groups after curative resection of hepatocellular carcinoma. The IHR group shows a better cumulative survival curve than the EHR group. The five-year survival rate of IHR and the EHR groups were 36.3% and 21.5%, respectively.
kjhbps-16-93-g001
Table 1
Sites of extrahepatic recurrence
kjhbps-16-93-i001
Table 2
A comparison of the clinical characteristics of recurrent hepatocellular carcinoma patients between the intrahepatic recurrence (IHR) and extrahepatic recurrence (HER) groups
kjhbps-16-93-i002

NBNC, non-B non-C infection; HBV, hepatitis B virus infection; HCV, hepatitis C virus infection; ICG R-15, indocyanine green retention rate at 15 min; AFP, alpha-fetoprotein; RBC, red blood cells

Table 3
Multivariate analysis predicting the extrahepatic recurrence after a hepatectomy
kjhbps-16-93-i003

CI, confidence interval

Table 4
Management of extrahepatic recurrence
kjhbps-16-93-i004

Mx, management; TACE, transarterial chemoembolization; ChemoTx, chemotherapy; OP, Operation; IVC, inferior vene cava; RT, radiation therapy

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