Although recent advances in surgical techniques and alternative treatment, the long-term survival >5 years after liver resection for hepatocellular carcinoma (HCC) is still unsatisfactory due to the high recurrence rate compared with other solid organ cancers. This study was conducted to analyze long-term survival after HCC resection and to develop an optimal strategy to achieve long-term survival.

A retrospective review was performed for HCC patients who underwent liver resection between 1996 and 2006. The survival rates and prognostic factors were assessed. The clinical and pathological factors of patients who survived more than 5 years were compared with those of patients whose survival was less than 5 years. The clinicopathological features characterizing long-term survivors were also reviewed.

The overall and disease-free 5-year survival rates of 87 cases were 38.5% and 29.4%, respectively. Twenty-seven of 87 patients survived longer than 5 years after liver resection. The univariate analysis revealed that hepatitis C, the serum aspartate sminotransferase (AST) level, liver cirrhosis, Edmondson-Steiner grade, AJCC stage, and vascular invasion were significant factors for overall survival, and serum AST level, liver cirrhosis, Edmondson-Steiner grade, AJCC stage, and vascular invasion were the affecting factors for disease-free survival. In multivariate analysis, serum AST level, hepatitis C and vascular invasion were related with the overall survival, liver cirrhosis and vascular invasion which were associated with disease-free survival. Vascular invasion, AJCC stage, and the Edmondson-Steiner grade were significant factors in long-term survivors.

Patients without liver cirrhosis, vascular invasion and normal liver function, good differentiation and an early stage may be expected to have a long-term survival.