Improvement of long-term outcomes in hepatitis C virus antibody-positive patients with hepatocellular carcinoma after hepatectomy in the modern era

Background: The present study was conducted to clarify the causes of recent improvement of outcomes after hepatectomy in patients with hepatitis C (HC)-related hepatocellular carcinoma (HCC). Methods: From 1990 to 2006, 323 curative liver resections for HC-HCC were performed in our department. The patients were divided into two groups: early period (1990-1999: n = 221) and the late period (2000-2006: n = 102). Prognostic factors were determined to clarify the cause of the survival improvement in the modern era. Results: The overall survival rates for the patients in the early and late periods were 54.9 and 70.3% at 5 years, respectively (P = 0.0005). There was no difference in the recurrence-free survival rates between the two groups, although both survival without recurrence (P = 0.0003) and survival after recurrence (P = 0.0063) were significantly better in the late period than in the early period. Patients with better liver function, patients with interferon (IFN) therapy and patients with subsegmentectomy were selected more frequently, and the incidence of blood transfusion was decreased in the late period below the level recorded in the early period. For recurrent HCC, lipiodolization decreased and local ablation therapy increased in the late period. The independent prognostic factors for overall survival were preoperative serum levels of albumin and alanine aminotransferase, histological liver cirrhosis, tumor size, intrahepatic metastasis, histological grade, blood transfusion, and IFN therapy. Conclusions: In HC-HCC, survival was improved in the late period of the present study. Selection of patients with good liver function, no blood transfusion with reduction of blood loss, anti-hepatitis C virus therapy with IFN, and introduction of local ablation therapy for HCC recurrence may be related to the improved survival.