Critical Appraisal of the Clinical and Pathologic Predictors of Survival After Resection of Large Hepatocellular Carcinoma

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dc.contributor.author Abdalla, Eddie
dc.contributor.author Pawlik, Timothy
dc.contributor.author Poon, Ronnie
dc.contributor.author Zorzi, Daria
dc.contributor.author Ikai, Iwao
dc.contributor.author Curley, Steven
dc.contributor.author Nagorney, David
dc.contributor.author Belghiti, Jacques
dc.contributor.author Oi-Lin Ng, Irene
dc.contributor.author Yamaoka, Yoshio
dc.contributor.author Lauwers, Gregory
dc.contributor.author Vauthey, Nicolas
dc.date.accessioned 2015-11-11T13:41:25Z
dc.date.available 2015-11-11T13:41:25Z
dc.date.copyright 2005
dc.date.issued 2015-11-11
dc.identifier.issn 2168-6254 en_US
dc.identifier.uri http://hdl.handle.net/10725/2536
dc.description.abstract Hypothesis A subset of patients with hepatocellular carcinoma (HCC) with a diameter of 10 cm or larger may benefit from hepatic resection. Design Retrospective study of a multi-institutional database. Setting Five major hepatobiliary centers. Patients We identified 300 patients who underwent hepatic resection for HCC 10 cm or larger. Main Outcome Measures Clinical and pathologic data were collected, and prognostic factors were evaluated by univariate and multivariate analyses. Patient survival was stratified according to a clinical scoring system and pathologic T classification. Results The perioperative mortality rate was 5%. At a median follow-up of 32 months, the median survival was 20.3 months, and the 5-year actuarial survival rate was 27%. Four clinical factors—α-fetoprotein of 1000 ng/mL or higher, multiple tumor nodules, the presence of major vascular invasion, and the presence of severe fibrosis—were significant predictors of poor survival (all P<.05). Patients were assigned a clinical score according to the following risk factors: 1, no factor; 2, one or two factors; or 3, three or four factors. On the basis of the clinical score, patients could be stratified into only 2 distinct prognostic groups: no factor (score of 1) vs 1 or more factors (score of 2 or 3) (P<.001). In contrast, when patients were stratified according to pathologic T classification, 3 distinct groups were identified: T1 vs T2 vs T3 and T4 combined (P<.001). Fifty-six percent of the patients with a clinical score of 2 and 20% of patients with a clinical score of 3 actually had T1 or T2 disease on pathologic examination. Conclusions Patients with large HCCs should be considered for liver resection as this treatment is associated with a 5-year survival rate exceeding 25%. Clinical predictors should not be used to exclude patients from surgical resection because these factors do not reliably predict outcome. en_US
dc.language.iso en en_US
dc.title Critical Appraisal of the Clinical and Pathologic Predictors of Survival After Resection of Large Hepatocellular Carcinoma en_US
dc.type Article en_US
dc.description.version Published en_US
dc.author.school SOM en_US
dc.author.idnumber 201100945
dc.author.woa N/A en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal JAMA Surgery en_US
dc.journal.volume 140 en_US
dc.journal.issue 5 en_US
dc.article.pages 450-458 en_US
dc.identifier.doi http://dx.doi.org/doi:10.1001/archsurg.140.5.450. en_US
dc.identifier.ctation Pawlik, T. M., Poon, R. T., Abdalla, E. K., Zorzi, D., Ikai, I., Curley, S. A., ... & Vauthey, J. N. (2005). Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Archives of surgery, 140(5), 450-458. en_US
dc.author.email eddie.abdalla@lau.edu.lb
dc.identifier.url http://archsurg.jamanetwork.com/article.aspx?articleid=508591

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