Prognostic impact of complications after resection of early stage hepatocellular carcinoma

Georgios Antonios Margonis, Kazunari Sasaki, Nikolaos Andreatos, Yujiro Nishioka, Toshitaka Sugawara, Neda Amini, Stefan Buettner, Masaji Hashimoto, Junichi Shindoh, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Resection is the most effective treatment for HCC. However, postoperative morbidity is common and its impact on long-term oncological outcome remains unclear. METHODS: Long-term outcomes of 774 patients who underwent curative resection for early stage HCC at Johns Hopkins Hospital and Toranomon Hospital were investigated after stratifying by the development of postoperative overall and infectious complications. RESULTS: A minor or major postoperative complication developed in 281 and 65 patients, respectively, while postoperative mortality was 1.3% (n=10). The 5-year cumulative recurrence and overall survival(OS) rates were 57.2% and 76.4%, respectively. Overall postoperative complications independently predicted worse OS in multivariable analysis (HR=1.42, P=0.021). Complication severity did not correlate with OS (P>0.05). While infectious complications were not independent predictors of OS, the combination of blood transfusion and infectious complications led to significantly worse OS (66.3% vs. 44.9%, P=0.008). Postoperative complications also correlated with increased recurrence risk, but only in patients with non-cirrhotic parenchyma (55.0% vs. 47.7%, P=0.035) or non-viral hepatitis (55.6% vs. 44.4%, P=0.002). CONCLUSIONS: Post-operative morbidity independently predicted poor OS following hepatectomy for early stage HCC. A similar effect on recurrence was noted only in patients with favorable etiopathologic factors. Finally, the combination of peri-operative transfusion and subsequent infectious complications was associated with a synergistic negative effect on prognosis.

Original languageEnglish (US)
JournalJournal of Surgical Oncology
DOIs
StateAccepted/In press - 2017

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Hepatocellular Carcinoma
Survival
Recurrence
Morbidity
Hepatectomy
Blood Transfusion
Hepatitis
Survival Rate
Mortality
Therapeutics

Keywords

  • Cirrhosis
  • Non-viral hepatitis
  • Transfusion

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Margonis, G. A., Sasaki, K., Andreatos, N., Nishioka, Y., Sugawara, T., Amini, N., ... Pawlik, T. M. (Accepted/In press). Prognostic impact of complications after resection of early stage hepatocellular carcinoma. Journal of Surgical Oncology. https://doi.org/10.1002/jso.24576

Prognostic impact of complications after resection of early stage hepatocellular carcinoma. / Margonis, Georgios Antonios; Sasaki, Kazunari; Andreatos, Nikolaos; Nishioka, Yujiro; Sugawara, Toshitaka; Amini, Neda; Buettner, Stefan; Hashimoto, Masaji; Shindoh, Junichi; Pawlik, Timothy M.

In: Journal of Surgical Oncology, 2017.

Research output: Contribution to journalArticle

Margonis, GA, Sasaki, K, Andreatos, N, Nishioka, Y, Sugawara, T, Amini, N, Buettner, S, Hashimoto, M, Shindoh, J & Pawlik, TM 2017, 'Prognostic impact of complications after resection of early stage hepatocellular carcinoma', Journal of Surgical Oncology. https://doi.org/10.1002/jso.24576
Margonis, Georgios Antonios ; Sasaki, Kazunari ; Andreatos, Nikolaos ; Nishioka, Yujiro ; Sugawara, Toshitaka ; Amini, Neda ; Buettner, Stefan ; Hashimoto, Masaji ; Shindoh, Junichi ; Pawlik, Timothy M. / Prognostic impact of complications after resection of early stage hepatocellular carcinoma. In: Journal of Surgical Oncology. 2017.
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abstract = "BACKGROUND: Resection is the most effective treatment for HCC. However, postoperative morbidity is common and its impact on long-term oncological outcome remains unclear. METHODS: Long-term outcomes of 774 patients who underwent curative resection for early stage HCC at Johns Hopkins Hospital and Toranomon Hospital were investigated after stratifying by the development of postoperative overall and infectious complications. RESULTS: A minor or major postoperative complication developed in 281 and 65 patients, respectively, while postoperative mortality was 1.3{\%} (n=10). The 5-year cumulative recurrence and overall survival(OS) rates were 57.2{\%} and 76.4{\%}, respectively. Overall postoperative complications independently predicted worse OS in multivariable analysis (HR=1.42, P=0.021). Complication severity did not correlate with OS (P>0.05). While infectious complications were not independent predictors of OS, the combination of blood transfusion and infectious complications led to significantly worse OS (66.3{\%} vs. 44.9{\%}, P=0.008). Postoperative complications also correlated with increased recurrence risk, but only in patients with non-cirrhotic parenchyma (55.0{\%} vs. 47.7{\%}, P=0.035) or non-viral hepatitis (55.6{\%} vs. 44.4{\%}, P=0.002). CONCLUSIONS: Post-operative morbidity independently predicted poor OS following hepatectomy for early stage HCC. A similar effect on recurrence was noted only in patients with favorable etiopathologic factors. Finally, the combination of peri-operative transfusion and subsequent infectious complications was associated with a synergistic negative effect on prognosis.",
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AU - Sasaki, Kazunari

AU - Andreatos, Nikolaos

AU - Nishioka, Yujiro

AU - Sugawara, Toshitaka

AU - Amini, Neda

AU - Buettner, Stefan

AU - Hashimoto, Masaji

AU - Shindoh, Junichi

AU - Pawlik, Timothy M.

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N2 - BACKGROUND: Resection is the most effective treatment for HCC. However, postoperative morbidity is common and its impact on long-term oncological outcome remains unclear. METHODS: Long-term outcomes of 774 patients who underwent curative resection for early stage HCC at Johns Hopkins Hospital and Toranomon Hospital were investigated after stratifying by the development of postoperative overall and infectious complications. RESULTS: A minor or major postoperative complication developed in 281 and 65 patients, respectively, while postoperative mortality was 1.3% (n=10). The 5-year cumulative recurrence and overall survival(OS) rates were 57.2% and 76.4%, respectively. Overall postoperative complications independently predicted worse OS in multivariable analysis (HR=1.42, P=0.021). Complication severity did not correlate with OS (P>0.05). While infectious complications were not independent predictors of OS, the combination of blood transfusion and infectious complications led to significantly worse OS (66.3% vs. 44.9%, P=0.008). Postoperative complications also correlated with increased recurrence risk, but only in patients with non-cirrhotic parenchyma (55.0% vs. 47.7%, P=0.035) or non-viral hepatitis (55.6% vs. 44.4%, P=0.002). CONCLUSIONS: Post-operative morbidity independently predicted poor OS following hepatectomy for early stage HCC. A similar effect on recurrence was noted only in patients with favorable etiopathologic factors. Finally, the combination of peri-operative transfusion and subsequent infectious complications was associated with a synergistic negative effect on prognosis.

AB - BACKGROUND: Resection is the most effective treatment for HCC. However, postoperative morbidity is common and its impact on long-term oncological outcome remains unclear. METHODS: Long-term outcomes of 774 patients who underwent curative resection for early stage HCC at Johns Hopkins Hospital and Toranomon Hospital were investigated after stratifying by the development of postoperative overall and infectious complications. RESULTS: A minor or major postoperative complication developed in 281 and 65 patients, respectively, while postoperative mortality was 1.3% (n=10). The 5-year cumulative recurrence and overall survival(OS) rates were 57.2% and 76.4%, respectively. Overall postoperative complications independently predicted worse OS in multivariable analysis (HR=1.42, P=0.021). Complication severity did not correlate with OS (P>0.05). While infectious complications were not independent predictors of OS, the combination of blood transfusion and infectious complications led to significantly worse OS (66.3% vs. 44.9%, P=0.008). Postoperative complications also correlated with increased recurrence risk, but only in patients with non-cirrhotic parenchyma (55.0% vs. 47.7%, P=0.035) or non-viral hepatitis (55.6% vs. 44.4%, P=0.002). CONCLUSIONS: Post-operative morbidity independently predicted poor OS following hepatectomy for early stage HCC. A similar effect on recurrence was noted only in patients with favorable etiopathologic factors. Finally, the combination of peri-operative transfusion and subsequent infectious complications was associated with a synergistic negative effect on prognosis.

KW - Cirrhosis

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