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Long-Term Prognosis After Resection of Hepatocellular Carcinoma Associated With Hepatitis B–Related Cirrhosis

From the Centre of Liver Diseases and Departments of Surgery and Pathology, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.

Address reprint requests to Ronnie Tung-Ping Poon, MD, Department of Surgery, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, China; email poontp{at}hkucc.hku.hk

PURPOSE: The optimum management of hepatocellular carcinoma (HCC) associated with cirrhosis has not yet been clarified. Very few data are available in the literature regarding the prognosis after resection of HCC associated with hepatitis B virus (HBV)–related cirrhosis. This study evaluated the long-term results and prognostic factors after resection of HCC complicating HBV-related cirrhosis.

PATIENTS AND METHODS: One hundred forty-six patients with HBV-related Child’s A or B cirrhosis who had undergone resection of HCC over a 10-year period were prospectively studied for long-term results. They were compared with 155 noncirrhotic patients with HBV-related HCC resected in the same period.

RESULTS: The overall survival results of cirrhotic patients after resection of HCC were comparable to those of noncirrhotic patients (5-year survival, 44.3% v 45.6%, respectively; P = .216), but the former group had significantly smaller tumors. Stratified according to tumor size, the survival results were similar between cirrhotic and noncirrhotic patients with tumors 5 cm (5-year survival, 60.7% v 61.7%, respectively; P = .327) but were worse in cirrhotic compared with noncirrhotic patients with tumors greater than 5 cm (5-year survival, 27.8% v 39.5%, respectively; P = .034). Stage by stage, there were no significant differences in survival results between cirrhotic and noncirrhotic patients. Preoperative serum AST level greater than 100 IU/L (P = .004), perioperative transfusion (P = .015), and venous invasion (P < .001) were independent adverse prognostic factors.

CONCLUSION: The prognosis after resection of HCCs less than 5 cm in patients with compensated HBV-related cirrhosis was comparable to that of noncirrhotic patients, which suggests that surgical resection may be considered a first-line treatment for these patients. Patients with underlying active hepatitis as indicated by a high preoperative transaminase level are less favorable candidates for resection. Further studies are needed to define the relative roles of resection and transplantation for HCC associated with hepatitis B cirrhosis.

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