Influence of liver fibrosis on prognosis after surgical resection for resectable single hepatocellular carcinoma

Abstract

Background: Surgical resection (SR) is recommended for single hepatocellular carcinoma (HCC) in patients with well-preserved liver function. However, unexpected liver fibrosis sometimes found at the SR which leads to a poor outcome. This study investigated the influence of liver fibrosis on prognosis after SR for HCC. Methods: A total of 189 patients with Child-Turcotte-Pugh grade A who underwent curative SR for a single HCC <5 cm were evaluated. Patients were assigned to two groups based on the degree of fibrosis (mild or severe), as determined by histological evaluation. Results: Severe fibrosis was present in 49 patients (25.9%); these patients had greater posthepatectomy liver failure (P = 0.000) and HCC recurrence (P = 0.016). Severe liver fibrosis (hazard ratio (HR) = 1.849, 95% confidence interval (CI) 1.191–2.869; P = 0.006), microvascular invasion (HR = 1.854, 95% CI 1.183–2.906; P = 0.007), and poor histologic grade (HR = 2.097, 95% CI 1.230–3.574; P = 0.007) were related to HCC recurrence. Conclusion: Severe fibrosis can be found even in patients with well-preserved liver function and it leads to poorer early post-operative and late oncologic outcomes, therefore it should be considered before therapeutic decision making of HCC. © 2018 Royal Australasian College of Surgeons