A long-term follow-up and management study of hepatocellular carcinoma patients surviving for 10 years or longer after curative hepatectomy

BACKGROUND. The aims of the current study were to elucidate the clinicopathologic characteristics and disease recurrence patterns of patients with hepatocellular carcinoma (HCC) who survived for 10 years or longer after undergoing an initial hepatectomy. METHODS. Between January 1987 and December 1993, 578 patients underwent potentially curative hepatectomy at the study institution. Disease recurrence and follow-up data were available for 481 of these patients, who then were followed for more than 10 years after the initial hepatectomy. Fourteen clinicopathologic features were compared between the 10-year survivors and those patients who died within 10 years after the surgery. The risk factors for disease recurrence, the recurrence status, time to recurrence, and treatment modalities for recurrence were examined among the 10-year survivors. RESULTS. There were 105 10-year survivors (21.8%), including 42 disease-free survivors (8.7%). Favorable independent factors found to be correlated with 10-year survival were age < 55 years, a plasma retention rate of indocyanine green at 15 minutes of < 15%, the presence of a solitary tumor, the absence of intrahepatic metastases, the absence of portal vein invasion, and the absence of underlying cirrhosis. A negative test for the the hepatitis C antibody and the absence of intrahepatic metastases were found to be independent predictive factors for 10-year disease-free survival among the 10-year survivors. CONCLUSIONS. The results suggest that younger patients without underlying cirrhosis who have a solitary HCC that does not demonstrate vascular invasion might Survive for longer than 10 years after the initial hepatectomy. In addition to close surveillance in such patients after hepatectomy, repeat hepatectomy, local ablation therapy, and transhepatic arterial chemoembolization may contribute to longterm survival, even if disease recurrence occurs.