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Sempokuya et al. Hepatoma Res 2019;5:38 I http://dx.doi.org/10.20517/2394-5079.2019.013 Page 7 of 10

Table 6. Predictors of 10-year survival after hepatic resection
Univariate odds-ratio (95%CI) Multivariate odds-ratio (95%CI)
Age ≥ 65 0.35 (0.14-0.88) 0.27 (0.43-4.50)
Sex (Males) 0.99 (0.40-2.45)
Hepatitis B 2.35 (1.01-5.45) 2.14 (0.75-6.10)
Hepatitis C 0.43 (0.139-1.32)
Alcohol history 1.16 (0.48-2.79)
NASH/NAFLD 0.20 (0.03-1.55)
HCC found with surveillance 1.59 (0.53-4.76)
BMI ≥ 25 0.27 (0.10-0.72) 0.32 (0.10-1.02)
BMI ≥ 30 0.36 (0.08-1.64)
Smoking 0.33 (0.13-0.80) 0.25 (0.09-0.74)
Diabetes 0.08 (0.01-0.57) 0.15 (0.02-1.22)
Hyperlipidemia 0.82 (0.31-2.22)
Hypertension 0.36 (0.15-0.85) 0.63 (0.22-1.82)
Normal AFP 0.65 (0.28-1.53)
Size ≥ 5 cm 0.96 (0.41-2.22)
Met Milan criteria 1.03 (0.43-2.49)
Rupture 0.60 (0.13-2.78)
Single tumor 1.09 (0.38-3.14)
Vascular invasion < 0.01 (0-inf)
Recurrence 0.88 (0.38-2.00)
Significant values are in bold. NASH: non-alcoholic steatohepatitis; NAFLD: non-alcoholic fatty liver disease; HCC: hepatocellular cancer;
BMI: body mass index; AFP: alpha feto protein

screenable diagnosis, symptoms at the diagnosis, size ≥ 5 cm, treatment modalities (transplantation: 23.4%,
resection: 50.9%, LRT: 85.7%). Age ≥ 65-year, AJCC staging, hypertension, hyperlipidemia, normal AFP,
ethnicity, tumor rupture, presence of single tumor, or vascular invasion were not significant predictors of
10-year survival. For transplantation, there was significant difference on tumor recurrence with 13.9 % had
recurrence for 10-year survivors and 35.7% had recurrence on non-survivors (P = 0.05). However, hepatic
resection did not have significant difference on recurrence (P = 0.92). There was no difference between
10-year survivors and non-survivors regarding treatment status of recurrence for both transplant and
hepatic resection. For transplantation, time to recurrence did not have significant difference between
10-year survivors and non-survivors. However, hepatic resection had significant difference (P < 0.001)
between 10-year survivors [median: 938, interquartile range (IQR): 730-2155] and non-survivors (median:
357, IQR: 155-514). There was significant difference (P > 0.001) between 10-year survivors (median: 4065,
IQR: 2,678-5,762) and non-survivors (median: 453, IQR: 174-1315) for recurrence free survival.

DISCUSSION
Characteristics of 10-year survivors vs . non-survivors
Survival after HCC has generally been related to the therapies that patients receive and which therapy they
receive is mainly dependent on tumor characteristics and underlying liver function. Because HCC is such a
heterogeneous neoplasm, the underlying liver function is further influenced by etiology of liver disease and
external factors such as alcohol, smoking, and metabolic factors. When all things were considered in this
study, patients who survived 10 years after diagnosis were more likely to be younger. Ten-year survivors
also had smaller tumor size and fewer of them exceeded 5 cm. They may also have better underlying liver
function as evidenced by lower liver enzymes and higher platelet count however fibrosis markers (FIB-4
and APRI) did not seem to differ between survivors and non-survivors. Previous studies have suggested
differences in long term survival based on etiology of chronic liver disease with a better prognosis in those
[20]
with viral hepatitis B or C compared to those with NASH or ALD . Others have shown that underlying
[21]
[14]
liver function can prognosticate long term survival . Wu et al. , in an evaluation of 8450 HCC patients
long-term, determined that 10-year survival was dependent on the number of lesions, the presence of