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Clinical significance of surgical resection of metastatic lymph nodes from hepatocellular carcinoma

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Abstract

Purpose

The clinical significance of the surgical resection of metastatic lymph nodes (LN) from patients with hepatocellular carcinoma (HCC) remains controversial. The aim of this study was to evaluate the significance of the surgical resection of LN metastasis of HCC.

Methods

Among 961 patients who underwent surgical resection for HCC in our hospital, LN metastasis was identified in 38 patients. In these patients, the metastatic LN were removed completely in 22 patients (complete removal group), and incompletely or not removed in 16 patients (control group). The long-term prognosis after LN metastasis was compared between the two groups.

Results

The overall survival rate after LN metastasis was significantly better in the complete removal group (1-, 3- and 5-year: 71.2, 58.0 and 49.7 %, respectively) than in the control group (45.9, 23.0 and 15.3 %, respectively, p = 0.0477). LN metastasis was not the cause of death in any of the patients in the complete removal group, whereas it was a cause in some patients in the control group. No local LN recurrence was identified in the complete removal group.

Conclusions

The present results suggest that the complete removal of metastatic LN from HCC is clinically beneficial in selected patients.

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References

  1. Arii S, Monden K, Niwano M, Furutani M, Mori A, Mizumoto M, Imamura M. Results of surgical treatment for recurrent hepatocellular carcinoma; comparison of outcome among patients with multicentric carcinogenesis, intrahepatic metastasis, and extrahepatic recurrence. J Hepatobiliary Pancreat Surg. 1998;5(1):86–92.

    Article  CAS  PubMed  Google Scholar 

  2. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med. 1999;340(10):745–50.

    Article  CAS  PubMed  Google Scholar 

  3. Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM, Wong J. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg. 2001;234(1):63–70.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg. 2003;238(5):703–10.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Nagao T, Inoue S, Goto S, Mizuta T, Omori Y, Kawano N, Morioka Y. Hepatic resection for hepatocellular carcinoma. Clinical features and long-term prognosis. Ann Surg. 1987;205(1):33–40.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Yamasaki T, Kurokawa F, Shirahashi H, Kusano N, Hironaka K, Okita K. Percutaneous radiofrequency ablation therapy with combined angiography and computed tomography assistance for patients with hepatocellular carcinoma. Cancer. 2001;91(7):1342–8.

    Article  CAS  PubMed  Google Scholar 

  7. Kobayashi T, Ishiyama K, Ohdan H. Prevention of recurrence after curative treatment for hepatocellular carcinoma. Surg Today. 2013;43(12):1347–54.

    Article  CAS  PubMed  Google Scholar 

  8. Ueno M, Hayami S, Tani M, Kawai M, Hirono S, Yamaue H. Recent trends in hepatectomy for elderly patients with hepatocellular carcinoma. Surg Today. 2014;44(9):1651–9.

    Article  PubMed  Google Scholar 

  9. Nagano H, Miyamoto A, Wada H, Ota H, Marubashi S, Takeda Y, Dono K, Umeshita K, Sakon M, Monden M. Interferon-alpha and 5-fluorouracil combination therapy after palliative hepatic resection in patients with advanced hepatocellular carcinoma, portal venous tumor thrombus in the major trunk, and multiple nodules. Cancer. 2007;110(11):2493–501.

    Article  CAS  PubMed  Google Scholar 

  10. Nagano H, Sakon M, Eguchi H, Kondo M, Yamamoto T, Ota H, Nakamura M, Wada H, Damdinsuren B, Marubashi S, et al. Hepatic resection followed by IFN-alpha and 5-FU for advanced hepatocellular carcinoma with tumor thrombus in the major portal branch. Hepatogastroenterology. 2007;54(73):172–9.

    CAS  PubMed  Google Scholar 

  11. Ota H, Nagano H, Sakon M, Eguchi H, Kondo M, Yamamoto T, Nakamura M, Damdinsuren B, Wada H, Marubashi S, et al. Treatment of hepatocellular carcinoma with major portal vein thrombosis by combined therapy with subcutaneous interferon-alpha and intra-arterial 5-fluorouracil; role of type 1 interferon receptor expression. Br J Cancer. 2005;93(5):557–64.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Sakon M, Nagano H, Dono K, Nakamori S, Umeshita K, Yamada A, Kawata S, Imai Y, Iijima S, Monden M. Combined intraarterial 5-fluorouracil and subcutaneous interferon-alpha therapy for advanced hepatocellular carcinoma with tumor thrombi in the major portal branches. Cancer. 2002;94(2):435–42.

    Article  CAS  PubMed  Google Scholar 

  13. Yang Y, Nagano H, Ota H, Morimoto O, Nakamura M, Wada H, Noda T, Damdinsuren B, Marubashi S, Miyamoto A, et al. Patterns and clinicopathologic features of extrahepatic recurrence of hepatocellular carcinoma after curative resection. Surgery. 2007;141(2):196–202.

    Article  PubMed  Google Scholar 

  14. Ercolani G, Grazi GL, Ravaioli M, Grigioni WF, Cescon M, Gardini A, Del Gaudio M, Cavallari A. The role of lymphadenectomy for liver tumors: further considerations on the appropriateness of treatment strategy. Ann Surg. 2004;239(2):202–9.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Sun HC, Zhuang PY, Qin LX, Ye QH, Wang L, Ren N, Zhang JB, Qian YB, Lu L, Fan J, et al. Incidence and prognostic values of lymph node metastasis in operable hepatocellular carcinoma and evaluation of routine complete lymphadenectomy. J Surg Oncol. 2007;96(1):37–45.

    Article  PubMed  Google Scholar 

  16. Watanabe J, Nakashima O, Kojiro M. Clinicopathologic study on lymph node metastasis of hepatocellular carcinoma: a retrospective study of 660 consecutive autopsy cases. Jpn J Clin Oncol. 1994;24(1):37–41.

    CAS  PubMed  Google Scholar 

  17. Yuki K, Hirohashi S, Sakamoto M, Kanai T, Shimosato Y. Growth and spread of hepatocellular carcinoma. A review of 240 consecutive autopsy cases. Cancer. 1990;66(10):2174–9.

    Article  CAS  PubMed  Google Scholar 

  18. Abe T, Furuse J, Yoshino M, Kinoshita T, Konishi M, Inoue K, Hasebe T. Clinical characteristics of hepatocellular carcinoma with an extensive lymph node metastasis at diagnosis. Am J Clin Oncol. 2002;25(3):318–23.

    Article  PubMed  Google Scholar 

  19. Une Y, Misawa K, Shimamura T, Ogasawara K, Masuko Y, Sato N, Nakajima Y, Uchino J. Treatment of lymph node recurrence in patients with hepatocellular carcinoma. Surg Today. 1994;24(7):606–9.

    Article  CAS  PubMed  Google Scholar 

  20. Zeng ZC, Tang ZY, Fan J, Qin LX, Ye SL, Zhou J, Sun HC, Wang BL, Wang JH. Consideration of role of radiotherapy for lymph node metastases in patients with HCC: retrospective analysis for prognostic factors from 125 patients. Int J Radiat Oncol Biol Phys. 2005;63(4):1067–76.

    Article  PubMed  Google Scholar 

  21. Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer. 1954;7(3):462–503.

    Article  CAS  PubMed  Google Scholar 

  22. Marsh JW, Dvorchik I, Bonham CA, Iwatsuki S. Is the pathologic TNM staging system for patients with hepatoma predictive of outcome? Cancer. 2000;88(3):538–43.

    Article  CAS  PubMed  Google Scholar 

  23. Toyoda H, Fukuda Y, Koyama Y, Nishimura D, Hoshino H, Katada N, Kato K, Hayakawa T. Case report: multiple systemic lymph node metastases from a small hepatocellular carcinoma. J Gastroenterol Hepatol. 1996;11(10):959–62.

    Article  CAS  PubMed  Google Scholar 

  24. Park YJ, Lim do H, Paik SW, Koh KC, Lee JH, Choi MS, Yoo BC, Nam HR, Oh DR, Park W, et al. Radiation therapy for abdominal lymph node metastasis from hepatocellular carcinoma. J Gastroenterol. 2006;41(11):1099–1106.

  25. Yamashita H, Nakagawa K, Shiraishi K, Tago M, Igaki H, Nakamura N, Sasano N, Siina S, Omata M, Ohtomo K. Radiotherapy for lymph node metastases in patients with hepatocellular carcinoma: retrospective study. J Gastroenterol Hepatol. 2007;22(4):523–7.

    Article  PubMed  Google Scholar 

  26. Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, Luo R, Feng J, Ye S, Yang TS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10(1):25–34.

    Article  CAS  PubMed  Google Scholar 

  27. Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359(4):378–90.

    Article  CAS  PubMed  Google Scholar 

  28. Nakamura M, Nagano H, Marubashi S, Miyamoto A, Takeda Y, Kobayashi S, Wada H, Noda T, Dono K, Umeshita K, et al. Pilot study of combination chemotherapy of S-1, a novel oral DPD inhibitor, and interferon-alpha for advanced hepatocellular carcinoma with extrahepatic metastasis. Cancer. 2008;112(8):1765–71.

    Article  CAS  PubMed  Google Scholar 

  29. Nakamura M, Nagano H, Wada H, Noda T, Ota H, Damdinsuren B, Marubashi S, Miyamoto A, Takeda Y, Umeshita K, et al. A case of hepatocellular carcinoma with multiple lung, spleen, and remnant liver metastasis successfully treated by combination chemotherapy with the novel oral DPD-inhibiting chemotherapeutic drug S-1 and interferon-alpha. J Gastroenterol. 2006;41(11):1120–5.

    Article  PubMed  Google Scholar 

  30. Uenishi T, Hirohashi K, Shuto T, Kubo S, Tanaka H, Sakata C, Ikebe T, Kinoshita H. The clinical significance of lymph node metastases in patients undergoing surgery for hepatocellular carcinoma. Surg Today. 2000;30(10):892–5.

    Article  CAS  PubMed  Google Scholar 

  31. Lau WY, Leung TW, Leung KL, Ho S, Leung N, Chan M, Lin J, Li AK. Cytoreductive surgery for hepatocellular carcinoma. Surg Oncol. 1994;3(3):161–6.

    Article  CAS  PubMed  Google Scholar 

  32. Yamamoto K, Takenaka K, Kawahara N, Shimada M, Shirabe K, Itasaka H, Nishizaki T, Yanaga K, Sugimachi K. Indications for palliative reduction surgery in advanced hepatocellular carcinoma. The use of a remnant tumor index. Arch Surg. 1997;132(2):120–3.

    Article  CAS  PubMed  Google Scholar 

  33. Miller DL, Katz NM, Pallas RS. Hepatoma presenting as a right atrial mass. Am Heart J. 1987;114(4 Pt 1):906–8.

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

Yoshito Tomimaru and co-authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan

    Yoshito Tomimaru, Hiroshi Wada, Hidetoshi Eguchi, Akira Tomokuni, Naoki Hama, Koichi Kawamoto, Shigeru Marubashi, Yuichiro Doki, Masaki Mori & Hiroaki Nagano

  2. Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan

    Koji Umeshita

  3. Department of Pathology, Osaka City University Hospital, Osaka, Japan

    Kenichi Wakasa

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  1. Yoshito Tomimaru
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  2. Hiroshi Wada
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Correspondence to Hiroaki Nagano.

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Tomimaru, Y., Wada, H., Eguchi, H. et al. Clinical significance of surgical resection of metastatic lymph nodes from hepatocellular carcinoma. Surg Today 45, 1112–1120 (2015). https://doi.org/10.1007/s00595-014-1028-8

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  • DOI: https://doi.org/10.1007/s00595-014-1028-8

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