Dynamic liver function is an independent predictor of recurrence-free survival after curative liver resection for HCC - A retrospective cohort study

Int J Surg. 2019 Nov;71:56-65. doi: 10.1016/j.ijsu.2019.08.033. Epub 2019 Sep 5.

Abstract

Background: Hepatocellular carcinoma is the fifth most prevalent cancer worldwide. High tumour recurrence is the most common cause of the impaired 5-year survival rate of 26-58% after hepatectomy. The aim of this study was to investigate the impact of preoperative dynamic liver function on long-term outcome.

Materials and methods: A total of 146 patients that underwent curative resection for HCC at our department from 2005 to 2016 were analysed. Univariate analysis was calculated using Kaplan-Meier method. Multivariable analysis was carried out with Cox regression.

Results: The cumulative 1-, 3-, 5-year survival rates were 83%, 42% and 14%, respectively. Multivariable Cox regression yielded that overall survival depends on disease recurrence, haemoglobin, number of tumours, liver cirrhosis, lymphatic vessel invasion, UICC stage and postoperative complications. The corresponding 1-, 3-, 5-year disease-free survival rates were 73%, 32% and 10%, respectively. Multivariable analysis yielded preoperative liver function capacity (HR 2.421; p = 0.014), vascular invasion (HR 2.116; p = 0.034) and UICC stage (HR 2.200; p = 0.037) as risk factors associated with disease-free survival. A subanalysis with respect to the degree of functional impairment implicated that severity of liver function impairment is correlated with the disease-free survival rate.

Conclusion: This study shows that preoperative dynamic liver function assessed by LiMAx test as well as severity of underlying liver disease have a significant impact on recurrence-free survival after curative hepatectomy. Patients presenting with impaired liver function should be evaluated for other treatment e.g. liver transplantation or receive closer oncological follow-up.

Keywords: Dynamic liver function; Hepatocellular carcinoma; LiMAx.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular / mortality*
  • Carcinoma, Hepatocellular / physiopathology
  • Carcinoma, Hepatocellular / surgery
  • Disease-Free Survival
  • Female
  • Hepatectomy / methods
  • Hepatectomy / mortality*
  • Humans
  • Kaplan-Meier Estimate
  • Liver / physiopathology
  • Liver Function Tests / statistics & numerical data*
  • Liver Neoplasms / mortality*
  • Liver Neoplasms / physiopathology
  • Liver Neoplasms / surgery
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / mortality
  • Postoperative Complications / mortality
  • Predictive Value of Tests
  • Preoperative Period
  • Retrospective Studies
  • Risk Factors
  • Survival Rate