The effect of alkaline phosphatase and intrahepatic metastases in large hepatocellular carcinoma

Background: Hepatectomy is the standard treatment for HCC. However, large HCC poses a difficult challenge because of the technical complexity of surgical resection and the fear of postoperative hepatic decompensation. We analyzed the outcome and prognostic factors in patients with large hepatocellular carcinoma (HCC >= 10 cm) after surgery. Methods: We retrospectively investigated the medical records of 91 patients who had undergone hepatectomy between January 2006 and June 2010. A survival analysis was performed utilizing the Kaplan-Meier method and prognostic factors were evaluated using Cox regression analysis. Results: Of the 91 patients evaluated, most tumors were associated with hepatitis B virus (HBV). The median tumor size was 12.3 cm (range, 10 to 21 cm), with microvascular invasion present in most patients. The postoperative mortality rate was 2.2%. The median disease-free survival and overall survival were six months and 41 months. The one-year, two-year, and three-year disease-free survival rates were 33.5%, 29.3%, and 18.8%, respectively. The one-year, two-year, and three-year overall survival rates were 73.9%, 63.7%, and 54.8%, respectively. Of the 89 surviving patients, 69 patients (77.5%) developed HCC recurrence during the mean follow-up period of 23.4 +/- 15.9 months. On multivariate analysis, the statistically significant factors that predicted HCC recurrence were ALP >= 80 IU/mL (P = 0.009) and intrahepatic metastases (P = 0.013). Conclusions: Our study suggests that preoperative ALP levels (>= 80 IU/L) and intrahepatic metastases could be utilized to monitor and predict recurrence in HCC patients.