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Che-Hua Chang, MD; Gar-Yang Chau, MD, MPH; Wing-Yiu Lui, MD; Shyh-Haw Tsay, MD; Kuang-Liang King, MD; Chew-Wun Wu, MD

Arch Surg. 2004;139:320-325.

Hypothesis  In patients with hepatocellular carcinoma who do not have cirrhosis, the clinicopathologic characteristics and long-term postresectional outcomes must be clarified and liver transplantation may also have a role in future treatment strategy.

Design  Case series. The mean (SD) follow-up time was 52.4 (33.8) months.

Setting  A tertiary care medical center.

Patients  From a prospective database, 445 patients with hepatocellular carcinoma who underwent hepatectomy were classified into 2 groups—those without cirrhosis (n = 223) and those with cirrhosis (n = 222). Clinicopathologic factors and postresectional outcomes were compared between these groups based on the new American Joint Committee on Cancer/Union Internationale Contre le Cancer TNM (sixth edition) staging system and the patient selection criteria for undergoing transplantation.

Main Outcome Measures  Postresectional disease-free and overall survival rates.

Results  Compared with patients with cirrhosis, patients without cirrhosis were younger, had a lower rate of viral hepatitis type C infection, and had more advanced TNM stage III disease. Also more of the patients who did not have cirrhosis had undergone major resection. The tumor recurrence rate was significantly lower in the noncirrhotic group than in the cirrhotic group (59.5% vs 69.5%, P = .03). The 5- and 10-year disease-free and overall survival rates of the noncirrhotic group were 36.8% and 25.7%, and 53.0% and 36.9%, respectively. The survival of the members of the noncirrhotic group was better than the survival of the members of the cirrhotic group for patients with early stage (TNM stage I or transplantable) diseases. The 5-year disease-free and overall survival rates in patients without cirrhosis with transplantable diseases were 54.8% and 70.0%, respectively.

Conclusions  In early stage diseases, patients without cirrhosis had significantly better survival rates than patients with cirrhosis. For a small hepatocellular carcinoma originating in a noncirrhotic liver, hepatic resection is a reasonable first-line treatment. Liver transplantation can be reserved as salvage treatment for patients with recurrent disease after hepatic resection.

From the Division of General Surgery, Departments of Surgery (Drs Chang, Chau, Lui, King, and Wu) and Pathology (Dr Tsay), Taipei Veterans General Hospital, and College of Medicine, National Yang-Ming University, Taipei, Taiwan.

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