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Page 2 of 10 Sempokuya et al. Hepatoma Res 2019;5:38 I http://dx.doi.org/10.20517/2394-5079.2019.013

patients receiving liver resections. Recurrence of HCC occurs in both 10-year survivors and non-survivors, but later
recurrence with aggressive treatment of the recurrence may allow for 10-year survival.

Keywords: Hepatocellular cancer, 10-year survival, liver transplantation, hepatic resection

INTRODUCTION
Hepatocellular cancer (HCC) is the fourth leading cause of cancer mortality in the world and the incidence
[1,2]
and mortality has been increasing in the USA . Survival for HCC has been prolonged by curative
[3]
therapies which include liver transplantation, hepatic resection and ablation . The overall 5-year survival
for patients with HCC is quite dismal and estimated at 10%-12%, however this is improved in patients with
localized HCC (30%) and those who undergo liver transplantation (70%-75%) . Efforts have been made to
[4,5]
promote early detection of HCC with surveillance programs as this can contribute to improved survival by
allowing patients to qualify for these curative therapies .
[6]
Despite these efforts and potentially curative therapies, recurrence occurs in about 54% of patients who
undergo resection and 8%-17% of those who undergo liver transplantation [7-10] . Recurrences have been
treated with repeat liver resections, salvage liver transplantation after resection and locoregional therapies,
however these recurrences are likely responsible for compromised long-term survival. While much of
the literature focuses on 5-year outcome, less is reported about longer term survival beyond 5 years. Late
recurrence, which occurs after 5 years, has been described in patients after resection or transplant [11-13] .
Others have suggested that underlying liver function as measured by albumin-bilirubin (ALBI) grade
correlated with recurrence free survival [14,15] .

There are few studies that report or critically evaluate 10-year survival from HCC. This is often difficult as
patients relocate, have other illnesses, are lost to follow-up or are no longer followed by the tertiary center
that performed the curative therapy. This study reviews a 26-year experience of patients in Hawaii with
HCC who have been followed by a group of physicians and the state’s only Liver Center and characterizes
patients with at least 10-year follow-up from curative therapies. Specifically, we identified 10-year survivors
and compared them to patients who received similar therapies who died before 10 years.

METHODS
Patients
Utilizing prospectively collected database of 1374 HCC patients from 1993 to 2019, there were 575 patients
who had at least 10 years of follow up. We identified those patients who survived at least 10 years regardless
of treatment. We then selected a comparison group of all patients who underwent liver transplantation or
liver resection and did not survive 10 years. We excluded patients who had liver transplantation or resection
who were still alive but did not have at least 10 years of follow up. This comparison group also excluded
patients who had non-surgical therapies and did not survive 10 years as this was a large heterogeneous
group of patients with more advanced HCC and/or severe cirrhosis who received locoregional therapy or
supportive care. This database is based on Hawaii’s only tertiary liver center and liver transplant program
and also includes patients from the American territories of the Pacific Basin. Approximately 60%-70% of
the HCC patients in Hawaii were referred to this center and included in this database. The diagnosis of
HCC was made histologically or based on contrast-enhanced computed tomography scan or magnetic
resonance imaging with typical HCC features based on guidelines published by the american association
for the study of liver disease . This study was approved by the university of hawaii at manoa institutional
[3]
review board.