Value of postoperative radiotherapy for centrally located hepatocellular carcinoma

Objective: To assess the effects of postoperative radiotherapy on the prognosis and recurrent patterns of centrally located hepatocellular carcinoma (HCC). Methods: From July 2007 to December 2011, 116 patients with centrally located HCC (resection margin < 1 cm) were treated by surgery, and 33 of them received postoperative radiotherapy. The prognosis and recurrent patterns were compared between the postoperative radiotherapy (PORT) group and surgery alone (SA) group. The Kaplan-Meier method was used to calculate disease-free survival (DFS) and overall survival (OS); the log-rank test was used for univariate analysis, and the Cox regression model was used for multivariate prognostic analysis. Results: The 1-, 3-, and 5-year sample sizes were 104, 89 and 83, respectively. The 1-, 3-, and 5-year DFS rates for PORT group were 82%, 64%, and 49%, respectively, versus 63%, 52%, and 22% for SA group (P=0.038); the 1-, 3-, and 5-year OS rates for PORT group were 97%, 89%, and 68%, respectively, versus 87%, 68%, and 46% for SA group (P=0.009). The numbers of patients with surgical margin recurrence, single recurrence beyond the margin, and diffuse recurrence in PORT group were 0, 11, and 2, respectively, versus 8, 11, and 18 in SA group (P=0.011); the numbers of patients with early recurrence (within 18 months after surgery) and late recurrence (at least 18 months after surgery) in PORT group were 6 and 7, respectively, versus 36 and 7 in SA group (P=0.016). Conclusions: Postoperative radiotherapy is safe and can significantly improve prognosis in patients with centrally located HCC. (authors)