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Resection of Hepatocellular Carcinoma Without Cirrhosis

Shrager, Brian MD; Jibara, Ghalib MD, MPH; Schwartz, Myron MD; Roayaie, Sasan MD

doi: 10.1097/SLA.0b013e31823e70a3
Original Articles

Objective: The aim of this study was to examine the features and outcomes of noncirrhotic patients undergoing resection for hepatocellular carcinoma.

Background: Ten percent to 40% of hepatocellular carcinoma cases arise within a noncirrhotic liver parenchyma. Resection is the standard therapy, yet the published resection series from the West are small.

Methods: From January 1987 to December 2009, our center performed 206 partial liver resections for nonfibrotic or minimally fibrotic (Scheuer stage 0–2) hepatocellular carcinoma. We retrospectively reviewed these cases and performed univariate and multivariate analyses for predictors of long-term outcomes.

Results: Eighty-one patients (39.3%) had chronic hepatitis B infection and 23 patients (11.2%) had chronic hepatitis C. The remaining 83 (39.8%) had no underlying liver disease. Average age was 60.2 years, and 68.4% of the patients were male. Average tumor size was 8.2 cm. Overall survival at 5 years was 46.3%. Recurrence at 5 years was 50.0%. Independent predictors for decreased survival were tumor size larger than 7.0 cm, creatinine more than 1.0 mg/dL, satellite nodules, albumin less than 3.5 gm/dL, alpha-fetoprotein more than 100 ng/mL, and any vascular invasion. Chronic hepatitis B virus infection predicted longer survival. Independent predictors for decreased time to recurrence were albumin less than 3.5 gm/dL, any vascular invasion, age more than 60 years, tumor size larger than 7.0 cm, and alpha-fetoprotein more than 100 ng/mL. Treatment of recurrence with either repeat resection or ablation was associated with a median survival of 50.4 months from time of recurrence.

Conclusions: Hepatocellular carcinoma can develop in a minimally fibrotic hepatitis C patient. Tumor-related factors such as vascular invasion primarily determine long-term outcomes. Hepatitis B virus-associated tumors seem to have a better prognosis in the nonfibrotic or minimally fibrotic population. Aggressive treatment of recurrence is warranted.

In this retrospective cohort study of 206 noncirrhotic patients undergoing resection of hepatocellular carcinoma in a large Western referral center, clinical and pathological features are examined, outcomes are reported, and independent predictive factors for recurrence and survival are discussed.

From the Mount Sinai Liver Cancer Program, Mount Sinai Medical Center, New York, NY.

Reprints: Brian Shrager, MD, Division of Surgical Oncology, The Mount Sinai Medical Center 19 E 98th St, Ste 7A, New York, NY 10029. E-mail:

Disclosure: The authors declare that they have nothing to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.