PURPOSE: A retrospective clinical study of 213 patients who underwent curative resection due to hepatocellular carcinoma was performed in order to compare the mortality and survival rates of elderly patients with those of younger patients following the resection. MATERIALS AND METHODS: All subjects underwent curative resection at Shinchon & Yongdong Severance Hospital between January 1985 to December 1994. The subjects were classified into three age groups: Group I (n=26) under 40, Group II (n=142) between 41 and 60, and Group III (n=45) over 60. Variables considered include sex, family history, accompanied diseases, Hbs Ag, -PF, Child classification, operative method, resection margin, number of mass, size of mass and gross-appearance were evaluated by X2-test (p=0.05). The one, three and five year survival rates were analysed in each group by the Kaplan- Meyer method and survival curves were compared by the log-rank test. A probability of <0.05 was accepted as significant. RESULTS: The results showed that elderly patients have no significant differences from the younger patients in any of the variables considered including postoperative morbidity, survival rate and disease-free survival rate, except for the family history and positive Hbs Ag in which the elderly patients showed significantly lower values. CONCLUSION: These results suggest that hepatocellular carcinoma in the aged can be treated in identical manner as in younger patients.
Aged ; Carcinoma, Hepatocellular* ; Child ; Classification ; Disease-Free Survival ; Humans ; Mortality ; Retrospective Studies ; Survival Rate

It has been approximately 30 years since Child-Turcotte-Pugh score has been used as a predictor of mortality in patients with liver cirrhosis and hepatocellular carcinoma (HCC). Recently, new prognostic models such as Model for End-Stage Liver disease (MELD), Short- and Long-term Prognostic Indices (STPI and LTPI), Rockall score, and Emory score were proposed for predicting survival in patients with liver cirrhosis treated by transjugular intrahepatic portosystemic shunt (TIPS). In MELD scoring, three independent variables which showed a wide range of results including serum creatinine, serum bilirubin and international normalization ratio (INR) of prothrombin time were evaluated in log(e) scale in comparison with simply categorized-into-three scoring system of Child-Turcotte-Pugh. The etiology of liver cirrhosis was applied to the score of MELD: alcoholic or cholestatic, 0; viral or others, 1. Concurrent statistic (C-statistic) of MELD (0.73-0.84) was slightly superior or insignificantly different to that (0.67-0.809) of Child-Turcotte-Pugh score. In February 2002, UNOS status 2a and 2b were replaced with MELD score for priority allocation of liver transplantation. MELD score does not reflect the severity of patients with HCC or metabolic disorders. For assessing prognosis in patients with liver cirrhosis or HCC, there seems little reason to replace the well established Child-Turcotte-Pugh score. Herein the literatures was briefly reviewed.
Bilirubin/blood ; Carcinoma, Hepatocellular/*classification/mortality ; Creatinine/blood ; Humans ; International Normalized Ratio ; Liver Cirrhosis/*classification/mortality/surgery ; Liver Neoplasms/*classification/mortality ; Portasystemic Shunt, Transjugular Intrahepatic ; Prognosis ; ROC Curve ; Risk Factors ; *Severity of Illness Index ; Survival Rate

No abstract available.
Bilirubin/blood ; Carcinoma, Hepatocellular/*classification/mortality ; Creatinine/blood ; Humans ; International Normalized Ratio ; Liver Cirrhosis/*classification/mortality/surgery ; Liver Neoplasms/*classification/mortality ; Portasystemic Shunt, Transjugular Intrahepatic ; Prognosis ; ROC Curve ; Risk Factors ; *Severity of Illness Index ; Survival Rate

BACKGROUND: The survival in patients with hepatocellular carcinoma (HCC) has recently been improved by the advancement in the early detection of HCC. Among the various treatment modalities, the surgical resection has been considered as the most effective for small HCC, and the clinical course of patients with small HCC who underwent curative resection is known to be dependent on the etiology of HCC. Since the differences in the etiology of HCC depend on the different geographical area, it is necessary to verify the clinical outcomes and their affecting factors in patients with small HCC after curative resection in Korea, one of the hepatitis- B-virus(HBU)-endemic areas. METHODS: A total of 89 patients with small HCC (mortality and morbidity occurred in 2.2% and 21% of patients, respectively. Cumulative recurrence rates at the end of 0.5, 1st, 2nd and 3rd year were 6.3Ya, 15.7%, 35.l% and 52.9%, respectively; cumulative probabilities of progression to hepatic decompensation at the end of 1st, 2nd and 3rd year were 4.2%, 19.4% and 22.6%, respectively; cumulative survival rates at the end of 0.5, 1st, 2nd and 3rd year were 91.1%, 89.9%, 77.9% and 74.5%, respectively. Six patients died as a result of tumor recurrence and eleven patients died of causes not related to tumor recurrence. The most important predictive factor of shorter survival time and higher rate of hepatic decompensation was vascular invasion. Age(>or=50 years old), Child's classification and vascular invasion were factors affecting the rate of recurrence. CONCLUSION: These results verify that the clinical outcomes of patients with small HCC after curative resection in Korea are similar to those of patients with different etiology of HCC in other geographic areas. To improve the prognosis of patients with small HCC after curative resection, strict preoperative evaluation of the presence of vascular invasion and postoperative preservation of liver function are necessary as well as the close postoperative follow-up for the early detection of recurrence.
Carcinoma, Hepatocellular* ; Classification ; Follow-Up Studies ; Hepatitis B Surface Antigens ; Humans ; Korea ; Liver ; Liver Cirrhosis ; Mortality ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate

BACKGROUND: To investigate the effects of acute kidney injury (AKI) after liver resection on the long-term outcome, including mortality and renal dysfunction after hospital discharge. METHODS: We conducted a historical cohort study of patients who underwent liver resection for hepatocellular carcinoma with sevoflurane anesthesia between January 2004 and October 2011, survived the hospital stay, and were followed for at least 3 years or died within 3 years after hospital discharge. AKI was diagnosed based on the Acute Kidney Injury Network classification within 72 hours postoperatively. In addition to the data obtained during hospitalization, serum creatinine concentration data were collected and the glomerular filtration rate (GFR) was estimated after hospital discharge. RESULTS: AKI patients (63%, P = 0.002) were more likely to reach the threshold of an estimated GFR (eGFR) of 45 ml/min/1.73 m² within 3 years than non-AKI patients (31%) although there was no significant difference in mortality (33% vs. 29%). Cox proportional hazard regression analysis showed that postoperative AKI was significantly associated with the composite outcome of mortality or an eGFR of 45 ml/min/1.73 m² (95% CI of hazard ratio, 1.05–2.96, P = 0.033), but not with mortality (P = 0.699), the composite outcome of mortality or an eGFR of 60 ml/min/1.73 m² (P =0.347). CONCLUSIONS: After liver resection, AKI patients may be at higher risk of mortality or moderate renal dysfunction within 3 years. These findings suggest that even after discharge from the hospital, patients who suffered AKI after liver resection may need to be followed-up regarding renal function in the long term.
Acute Kidney Injury* ; Anesthesia ; Carcinoma, Hepatocellular ; Classification ; Cohort Studies ; Creatinine ; Glomerular Filtration Rate ; Hepatectomy ; Hospitalization ; Humans ; Length of Stay ; Liver* ; Long Term Adverse Effects ; Mortality

OBJECTIVE: Although metastasis of hepatocellular carcinoma to the brain is uncommon, it is associated with a very high mortality rate and most patients usually expire within 1 year after brain metastasis. The aim of this study is to identify the effectiveness of the active interventions such as gamma knife radiosurgery or surgical intervention for these patients. METHODS: We retrospectively reviewed the medical records and imaging data of 59 patients with metastatic brain tumors from hepatocellular carcinoma from May 2004 to September 2012. The study included patients with available clinical and radiological data who had been diagnosed with metastatic hepatocellular carcinoma of the brain, confirmed by magnetic resonance imaging. The overall survival time was analyzed and compared according to each risk factor. RESULTS: The mean age at diagnosis of metastatic brain tumor was 52.2 years (14-77). The mean follow-up duration was 13.3 weeks (0.1-117.6). Overall median survival was 4.3 weeks (95% confidence interval, 2.2-6.4). The results from an analysis of clinical factors related to survival revealed that treatment modalities were significantly related to the patient's survival (log rank, p=0.006). Twenty patients (32.8%) experienced tumor bleeding, and the survival time of the patients with tumor bleeding tended to be shorter, although the result was not statistically significant (log rank, p=0.058). Hepatic reserve, by Child-Pugh classification, was grade A in 38 patients (64.4%), grade B in 16 patients (27.1%), and grade C in 5 patients (8.5%), and was significantly related to the patient's survival (log rank, p=0.000). CONCLUSION: Although patients with metastatic brain tumors from hepatocellular carcinoma showed poor survival, active intervention including surgical resection or gamma knife radiosurgery may result in better survival, especially if patients have preserved liver function.
Brain Neoplasms* ; Brain* ; Carcinoma, Hepatocellular* ; Classification ; Diagnosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver ; Magnetic Resonance Imaging ; Medical Records ; Mortality ; Neoplasm Metastasis ; Radiosurgery* ; Retrospective Studies ; Risk Factors

OBJECTIVE: To evaluate the impact of preoperative transarterial chemoembolization (TACE) for the treatment of patients undergoing curative liver resection for hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Preoperative TACE was performed in 164 of 339 HCC patients that had a curative resection and follow-up. Retrospective clinico-pathological analysis was performed with regard to the safety and response to treatment, early and late incidence and the pattern of recurrence as well as survival. RESULTS: For 159 patients in the TACE group (96.9%), TACE was performed preoperatively only once. The mean waiting time from TACE to resection was 19.5 days. There was no difference in the operative time, postoperative mortality and duration of hospital stay after resection between the two groups (patients that underwent TACE and patients that did not undertake the procedure). Ed-highlight-you did not define the two groups-is the above description in parentheses accurate? Microvascular invasion was significantly decreased in the TACE group (p < 0.01) and complete necrosis of the tumor was induced in 21 patients (12.8%) of the TACE group. Early and late recurrence patterns were not different between patients in the two groups. Overall survival and disease-free survival rate was not different between patients in both groups. However, the 3 year disease-free survival rate was significantly improved in the TACE group (p = 0.04) and the 3 year disease-free survival rate was also improved (p = 0.06), especially for patients with AJCC stage I or II. Multivariate analysis showed microvascular invasion, large tumor size, the presence of daughter nodules, gross portal invasion, Child classification and histological stage of cirrhosis to be risk factors for HCC recurrence and poor survival. CONCLUSION: Preoperative TACE is a safe procedure and can improve early postoperative recurrence and survival, especially in stage I or II HCC patients.
Carcinoma, Hepatocellular* ; Child ; Classification ; Disease-Free Survival ; Fibrosis ; Follow-Up Studies ; Humans ; Incidence ; Length of Stay ; Liver ; Mortality ; Multivariate Analysis ; Necrosis ; Nuclear Family ; Operative Time ; Recurrence ; Retrospective Studies ; Risk Factors

PURPOSE: Gastric variceal bleeding in cirrhotic patient is an emergent, life threatening disease of which the adequate treatment is still in dispute. The periesophagogastric devascularization (PD) would be the alternative operative procedure. The aim of this study is to evaluate the safety and long-term results of PD for the gastric fundal variceal bleeding. METHODS: A retrospective analysis was made of fifty-two patients with gastric variceal bleeding who underwent PD with or without fundectomy from August 1994 to March 2006. We evaluated the clinical characteristics, operative morbidity, mortality and long-term follow up results. RESULTS: The operative morbidity was 34.9% and overall mortality was 17.3%. The Child-Pugh classification at operation, the number of previous varix bleeding episode, the success of preoperative intervention, splenectomy, esophageal transection, and ongoing bleeding at operation had a significant effect on postoperative mortality. Most common cause of postoperative death was hepatic failure. Child-Pugh classification and esophageal transection were significant risk factor for postoperative mortality comparing before and after year 2001. During the mean follow-up period of 33.58+/-27.08 months, there was no recurrent bleeding from gastric varices. The cumulative 5-year survival rate was 64.1%. 0f 14 patients deceased, 6 patients died of hepatocellular carcinoma. Not only there was no death caused by recurrent variceal bleeding, but there was no recurrent gastric variceal bleeding. Hepatic functional reserve and concomitant hepatocellular carcinoma were the most important prognostic factors in the long term survival by multiple regression analysis. CONCLUSION: We concluded that PD reached both low postoperative mortality and recurrent bleeding rate with good long-term survival. So it could be one of the most effective treatment for the gastric fundal variceal bleeding.
Carcinoma, Hepatocellular ; Classification ; Dissent and Disputes ; Esophageal and Gastric Varices* ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver Cirrhosis ; Liver Failure ; Mortality ; Retrospective Studies ; Risk Factors ; Splenectomy ; Surgical Procedures, Operative ; Survival Rate ; Varicose Veins

PURPOSE: The long-term outcome after liver resection for hepatocellular carcinoma (HCC) is somewhat disappointing because of tumor recurrence. The purposes of this study were to evaluate the prognostic factors and to suggest the data to improve the long-term outcome of hepatic resection for HCC. METHODS: A retrospective survey was carried out in 200 patients undergoing hepatic resection for HCC from April 2001 to June 2004. The various clinicopathologic factors were analysed for the overall survival (OS) and the disease-free survival (DFS) rates by the univariate test (log rank test) and multivariate test (Cox regression model). RESULTS: There were one hospital mortality and 23% morbidity after partial hepatectomy. Intraoperative transfusion was given to 20 patients (10%). Mean follow-up period was 19 months (range, 2-43). The 1-, 2- and 3-year OS rates after hepatic resection for HCC were 90.5%, 86.8% and 76.2% and the 1-, 2- and 3-year DFS rates were 65.5%, 54.3% and 49.4%, respectively. By the univariate analysis for OS, aspartate aminotransferase (AST), Child-Pugh classification, Edmondson-Steiner histologic grade, microvascular invasion, major vessel invasion, alpha-fetoprotein (AFP), TNM stage, transfusion, surgical margin involvement and presence of complication were significant for survival. By the multivariate analysis, Child-Pugh classification, Edmondson-Steiner histologic grade, major vessel invasion and complication were independent risk factors for OS. Whereas viral marker, Child-Pugh classification, microvascular invasion, major vessel invasion, AFP, TNM stage, surgical margin involvement and presence of complication were the significant risk factors for DFS by the univariate analysis, viral marker, microvascular invasion, major vessel invasion, surgical margin involvement and presence of complication were the independent predictive factors of the DFS. CONCLUSION: Hepatic resection for HCC has become safe. To improve the long-term outcome of hepatic resection for HCC, the patients with poor liver function or major vessel invasion should be precluded in hepatic resection, if possible, and adequate surgical margin and avoidance of complication are mandatory.
alpha-Fetoproteins ; Aspartate Aminotransferases ; Biomarkers ; Carcinoma, Hepatocellular* ; Classification ; Disease-Free Survival ; Factor Analysis, Statistical* ; Follow-Up Studies ; Hepatectomy ; Hospital Mortality ; Humans ; Liver ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Risk Factors

PURPOSE: Our study aimed to investigate prognostic factors at presentation and the survival of patients with a resected hepatocellular carcinoma (HCC). METHODS: A retrospective analysis of medical records was performed for 58 patients (59 cases) identified through the Tumor Registry as having been evaluated for a hepatocellular carcinoma at the Chonbuk National University Hospital during the 10-year period from 1989 to 1999. RESULTS: The male:female ratio was 3.2:1, and the average age was 52.7 years. Liver cirrhosis and ascites were present in 64.4% and 8.5% of the patients, respectively, and 62.7% present with the HBs antigen. The positive alpha-fetoprotein (AFP) rate was 55.9% and the elevated alkaline phosphatase (ALP) rate was 32.2%. The Child-Pugh's classifications of the patients were as follows: 49 cases (83.1%) of Grade A, 8 cases (13.6%) of Grade B, 2 cases (3.4%) of Grade C. The Indocyanine green (ICG) tests of normal range (<10%) were 69.5%. The operative mortality was 3.4% (2 cases). Preopertive transarterial chemoembolization was performed in 23 cases (39.0%). The tumor was larger than 5 cm in 50.8% of the patients and was a single tumor in 72.9%. Portal vein invasion was present in 11.9% of the cases. The surgical procedure consisted of a curative resection in 43 cases (72.9%: lobectomy in 7, trisegmentectomy in 4, segmentectomy in 22, and wedge resection in 10) and a limited resection in 16 cases (27.1%). Of the patients, 44.1% had either TNM stage III or stage IV tumor. Recurrence of the tumor was diagnosed in 19 cases and was found in the residual liver in 13 cases (68.4%). Operative morbidity developed in 16 cases (27.1%) and hepatic failure, pleural effusion, ascites were common complications. CONCLUSION: A significantly higher survival rate was seen for HCC with no ascites and a normal ALP level. A curative resection was not superior to a limited resection in terms of survival. Recent management strategy and technical advances have improved the results of surgical treament for patients with a HCC.
Alkaline Phosphatase ; alpha-Fetoproteins ; Ascites ; Carcinoma, Hepatocellular* ; Classification ; Humans ; Indocyanine Green ; Jeollabuk-do ; Liver ; Liver Cirrhosis ; Liver Failure ; Mastectomy, Segmental ; Medical Records ; Mortality ; Pleural Effusion ; Portal Vein ; Prognosis* ; Recurrence ; Reference Values ; Retrospective Studies ; Survival Rate