Liver resection found safe for multinodular HCC with cirrhosis

  • Li ZL & al.
  • Eur J Surg Oncol
  • 21 Dec 2018

  • curated by Jim Kling
  • Univadis Clinical Summaries
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  • Patients with multinodular (≥3 nodules) hepatocellular carcinoma (HCC) and cirrhosis undergoing liver resection had similar 30-day postoperative mortality and morbidity as patients without multinodular disease.
  • Factors associated with worse outcomes included greater tumor numbers, tumor diameter, and microvascular invasion.

Why this matters

  • Liver resection in patients with multinodular HCC with cirrhosis is controversial because of the potential for surgical complications.
  • The results could assist with patient selection for resection.

Study design

  • Retrospective multicenter analysis (n=1066; 160 [15%] with multinodular HCC).
  • Funding: National Natural Science Foundation of China; Shanghai Pujiang Program.

Key results

  • Postoperative 30-day results, nonmultinodular vs multinodular:
    • Mortality: 1.8% vs 1.9% (P=.923).
    • Major morbidity: 7.1% vs 7.5% (P=.843).
  • Over the course of 60.1 months follow-up, multinodular vs nonmultinodular:
    • 5-year OS: 34.6% vs 58.2% (P<.001>
    • 5-year recurrence-free survival (RFS): 24.7% vs 44.5% (P<.001>
    • Median OS: 46.0 months vs 78.4 months (P<.001>
    • Median RFS: 11.1 months vs 29.6 months (P<.001>
  • Multinodular (
  • OS: HR, 1.935 (P<.001>
  • RFS: HR, 1.810 (P=.011).
  • Multinodular (total tumor diameter
  • OS: HR, 1.653 (P=.010).
  • RFS: HR, 1.682 (P=.004).
  • Multinodular (microvascular invasion):
    • OS: HR, 1.686 (P=.002).
    • RFS: HR, 2.035 (P=.020).
  • Limitations

    • Retrospective analysis.

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