Analysis of the recurrence risk factors for the patients with hepatocellular carcinoma meeting University of California
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Analysis of the recurrence risk factors for the patients with hepatocellular carcinoma meeting University of California San Francisco criteria after curative hepatectomy Ruey-Shyang Soong, Ming-Chin Yu, Kun-Ming Chan, Hong-Shiue Chou, Ting-Jung Wu, Chen-Fang Lee, Tsung-Han Wu, Wei-Chen Lee* Introduction Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, especially in the Asia pacific area [1]. Liver transplantation is theoretically the best option because it cures both the tumor and the underlying liver disease. The overall survival rate at 5 years after liver transplantation was around 70-75% [2]. In contrast, 5-year survival rates after liver resection were only 40% to 65%, and the 10-year survival rate was 29%. The high incidence of HCC recurrence following liver resection is a serious issue. The recurrent rate is as high as 50-60% at 3 years and 70-100% at 5 years. This high recurrent rate precludes long-term tumor-free survival of the patients with liver resection for HCC. However, liver transplantation is limited by a shortage of graft availability. Liver transplantation also has high perioperative risk, and long-term problems such as graft rejection and infections[3]. Therefore, liver resection is still the primary selection treatment for many HCC patients, especially in areas lacking deceased liver. Nevertheless, there is no doubt that for HCC, liver transplantation is a superior treatment option to liver resection, where long-term tumor-free survival is concerned. Adult-to-adult living donor liver transplantation is a well-established technique now. Liver transplantation for patients with HCC becomes feasible if a living donor wishes to donate part of the liver to save a member of the family. To optimize the benefit of living donor liver transplantation for HCC patients, the
* Correspondence: [email protected] Chang-Gung Transplantation Institute, Department of General Surgery, Chang-Gung Memorial Hospital, Chang-Gung University Medical School, Taipei, Taiwan
question of how to select the right patients to have liver transplantation is very important. This study aims to identify the patients who accepted hepatectomy for a tumor/tumors and were within University of California San Francisco (UCSF) criteria[4], but had a poor 5-year disease-free survival rate (DFS). We analyze the pre-operative data of the patients and attempt to find the pre-operative risk factors of HCC recurrence. These risk factors could be indicators for clinical doctors to define and identify the patients with a high risk of tumor recurrence and to arrange liver transplantation rather than hepatectomy as the first treatment option.
Materials and methods Patients
A total of 1595 patients underwent hepatectomy for HCC from 1983 to 2005 in Chang Gung Medical hospital, Taipei, for whom data were collected. The patient selection criteria in this study were (1) tumor number and size within UCSF criteria, (2) no major vessel invasion, (3) no distal metast
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