Effectiveness of Hepatic Resection for Early-stage Hepatocellular Carcinoma in Cirrhotic Patients: Subgroup Analysis according to Milan Criteria

Background: The aim of this study was to determine the long-term post-resection outcomes for cirrhotic patients with early-stage hepatocellular carcinoma (HCC). Methods: A total of 217 65-year-old cirrhotic patients who underwent hepatic resection were divided into four groups in accordance with the Milan criteria: Group 1, those who met the Milan criteria (n 130); Group 2A, those with a solitary tumor.5 cm in size (n 12); Group 2B, those with 2 or 3 tumors.3 cm in size (n 35); and Group 2C, those with 4 tumors (n 33). Overall and recurrence-free survival were compared between the groups. Results: At 1, 3, 5 and 10 years, overall survival rates were 91, 67, 45 and 12%, and recurrence-free survival rates were 62, 26, 16 and 0%, respectively. Independent prognostic factors for overall survival were age, blood transfusion, tumor number, tumor size and micro-scopic vascular invasion; and for recurrence they were hepatitis C infection, tumor number, tumor size, microscopic vascular invasion and histological tumor grade. Group 1 patients had significantly better survival (5-year survival rate, 56%) than those of other groups (5-year sur-vival rate, around 30%). The median tumor-free survival time was significantly shorter in Groups 2B and 2C (0.7 years and 0.6 years, respectively) than in Groups 1 and 2A