Influence of coexisting cirrhosis on long-term prognosis after surgery in patients with hepatocellular carcinoma.

BACKGROUND: As one of the reasons for the poor prognosis of patients with hepatocellular carcinoma (HCC) and cirrhosis, the influence of cirrhosis itself has not been clarified. METHODS: We compared the postoperative long-term courses of patients with HCC and cirrhosis with the courses of patients with HCC and without cirrhosis to determine how the coexisting cirrhosis affected the prognosis after surgery. The patients with HCC who underwent curative hepatic resection consisted of 142 with associated histologically confirmed cirrhosis and 48 without cirrhosis. RESULTS: The 5-, 7-, and 9-year survival rates were 44%, 32%, and 26%, respectively, in the patients with cirrhosis and 68%, 57%, and 57%, respectively, in the patients without cirrhosis. The prognosis of the group with cirrhosis was significantly worse than that of the group without cirrhosis. The main cause of death in both groups was cancer recurrence. The patients with cirrhosis had significantly lower recurrence-free survival rates at 3 years and later than had the patients without cirrhosis. A comparison of the background factors revealed no substantive disadvantages with regard to tumor-related and surgical factors in the patients with cirrhosis compared with the patients without cirrhosis. The recurrence-free survival rates after minor and major resection indicated fewer disadvantages of limited hepatectomy in the group with cirrhosis than in the group without cirrhosis. Moreover, the recurrence-free survival of the group with cirrhosis was shorter at less advanced stages than at more advanced stages when compared with that of the group without cirrhosis. CONCLUSIONS: The higher carcinogenic potential in cirrhosis could be presumed to be the most likely reason for the poorer prognosis after surgery in the patients with HCC and cirrhosis.