Risk factors for tumor recurrence and prognosis after curative resection of hepatocellular carcinoma

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Abstract
Methods. Eighty‐three patients with hepatocellular carcinoma (HCC) were treated with curative surgical resection during the past 8 years. Results. No operative deaths occurred. The cumulative recurrence rates after resection at the ends of years 1, 2, and 3 were 37.0%, 57.1%, and 71.6%, respectively. After adjusting the imbalance in clinical factors among patients by using a Cox proportional‐hazards model, it was shown that multiplicity, histologic classification, and absence of antibody to hepatitis C virus were associated significantly with recurrence after resection. The size of the tumor did not affect the incidence of recurrence. Thirty‐eight of 41 patients with intrahepatic tumor recurrence had undergone at least one of the following three therapies against HCC: surgical reresection, percutaneous ethanol injection (PEI), and transcatheter arterial embolization (TAE). The most significant factor affecting the survival time of patients with tumor recurrence was the total number of tumor nodules at the time of recurrence. Although surgery and PEI were thought to be more effective treatments than TAE in prolonging life, multivariate analysis showed that they were not significant factors of survival time because choices in the method of treatment were correlated closely with the number of cancer nodules. A 65.3% 5‐year survival rate from the time of first surgery was accomplished through vigorous therapy when tumors recurred. Conclusion. In conclusion, despite the high recurrence rate after resection of HCC, the use of multiple therapies can achieve increased survival rates. Cancer 1993; 71:19‐25.