Role of surgical resection for multiple hepatocellular carcinomas

Table 1 Clinical characteristics of the surgical resection patients vs the transarterial chemoembolization patients

Variable	Surgical resection(n = 36)	TACE(n = 107)	P value
Age (yr)	54.3 ± 8.6	61.2 ± 9.3	< 0.001
Gender (male:female)	34:2	86:21	0.047
Platelet (k/mm3)	153.4 ± 53.9	121.0 ± 51.8	0.002
Albumin (g/dL)	4.05 ± 0.50	3.93 ± 0.48	0.203
ALT (IU/L)	36.4 ± 15.8	59.0 ± 40.4	0.001
AST (IU/L)	41.2 ± 25.8	53.2 ± 44.7	0.130
HBsAg	28 (77.8)	67 (62.6)	0.099
Clinical liver cirrhosis	20 (55.6)	100 (93.5)	< 0.001
Tumor number			0.549
2	30 (83.3)	90 (84.1)
3	6 (16.7)	17 (15.9)
Main tumor size (cm)			0.005
< 3	19 (52.8)	17 (47.2)
≥ 3	29 (27.1)	78 (72.9)
AFP > 1000 IU/mL	2 (5.6)	8 (7.5)	0.696

Data are expressed as absolute n (%) or mean ± SD. M: Male; F: Female; TACE: Transarterial chemoembolization; ALT: Alanine aminotransferase (reference range, 5-46 IU/L); AST: Aspartate aminotransferase (reference range, 13-34 IU/L); HBsAg: Hepatitis B surface antigen; AFP: α-fetoprotein.

Table 2 Operative procedures in the resection group

Degree of resection	Operative procedure	Number of patients (n = 36)
Major resection	Extended right hepatectomy	1
(n = 19)	Right hepatectomy only	12
	+ wedge resection	1
	+ RFA	1
	Left hepatectomy only	1
	+ wedge resection	1
	Central bisectionectomy only	2
Minor resection	Left lateral sectionectomy only	3
(n = 17)	+ RFA	1
	Sectionectomy only	2
	+ wedge resection	2
	+ RFA	2
	Bisegmentectomy only	1
	+ wedge resection	1
	+ RFA	2
	Segmentectomy only	1
	+ RFA	1
	Wedge resection + RFA	1

En bloc resection (n = 23); multi-site resection (n = 5); resection plus radiofrequency ablation (RFA) (n = 8).

Table 3 Prognostic factors for overall survival in surgical resection patients

Variable	Patients(n = 36)	1-yr OS	3-yr OS	5-yr OS	P value
Age (yr)					0.146
≤ 60	27	88.9%	81.5%	42.3%
> 60	9	100%	88.9%	66.7%
Gender					0.245
Male	34	91.2%	82.4%	45.1%
Female	2	100%	100%	100%
Serum albumin (g/dL)					0.642
≤ 3.5	10	90.0%	60.0%	48.0%
> 3.5	26	92.3%	87.7%	46.1%
ALT (IU/L)					0.593
≤ 50	27	92.6%	81.5%	53.7%
> 50	9	88.9%	71.1%	23.7%
AST (IU/L)					0.87
≤ 50	31	90.3%	80.6%	52.4%
> 50	5	100%	100%	50.0%
ICG R 15 (%)					0.992
≤ 14	25	92.0%	84.0%	47.1%
> 14	9	88.9%	77.8%	58.3%
α-fetoprotein					0.471
≤ 1000 IU/mL	32	90.6%	81.3%	47.3%
> 1000 IU/mL	4	100%	100%	50.0%
Cirrhosis					0.023
No	16	100%	93.8%	69.9%
Yes	20	85.0%	75.0%	26.5%
Main tumor size (cm)					0.629
< 3.0	17	94.1%	86.3%	43.1%
≥ 3.0	19	89.5%	73.7%	52.6%
Number of tumors					0.061
2	31	90.3%	80.6%	40.7%
3	5	100%	100%	100%
Lobar distribution of tumors					0.892
One lobes	24	91.7%	83.3%	49.4%
Two lobe	12	91.7%	83.3%	48.6%
Operation type					0.568
En bloc resection	23	91.3%	82.6%	43.4%
Multiple resection or combined with RFA	13	92.3%	84.6%	57.1%

OS: Overall survival; RFA: Radiofrequency ablation; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ICG R 15: Indocyanine green retention rate at 15.