Risk factors for early death due to recurrence after liver resection for hepatocellular carcinoma: Results of a multicenter study

Abstract

Background and Objectives: Recurrence after partial liver resection for hepatocel-lular carcinoma (HCC) is a major cause of death from this disease. To identify riskfactors for early death from recurrence after liver resection for HCC.Methods: All 547 patients in this study had greater than 1 year of follow-up aftercomplete resection of HCC (1980–1999) at one of the four hepatobiliary centers inJapan, France, and the United States. Patients who died of recurrence 1 year post-resection and all of those alive at least 1 year were compared. Survival and clinico-pathological factors associated with death from recurrence within 1 year of resectionwere analyzed.Results: Overall postoperative mortality rate was 5%. In the first postoperative year,123 (22%) patients died. Of these, 53 (43%) died of recurrence, 30 (24%) of post-operative complications, and 40 (33%) of liver failure/hemorrhage. On multivariateanalysis, tumor size greater than 5 cm (P < 0.02; odds ratio, 3.0), multiple tumors(P < 0.01; odds ratio, 3.3), and greater than 5 mitoses per 10 high-power fields(P < 0.03; odds ratio, 3) were associated with increased risk of early death due torecurrence.Conclusions: These findings enable identification of patients with HCC who are athigh risk for early death due to recurrence following potentially curative resection whomight be candidates for adjuvant therapy trials.