1. Clinical features of resected hepatocellular carcinoma emerging after sustained virological response against chronic hepatitis C
Hepato-biliary-pancreatic Surgery Divion,
Department of Surgery, Tokyo Metropolitan Bokutoh Hospital
Baongoc Pham, Yasuji Seyama, Junichi Shindoh, Masaki Matsuda, Dai Shida, Tsuyoshi Maeshiro, Sachio Miyamoto, Satoru Inoue, Nobutaka Umekita

2. Introduction
Progress in anti-viral therapy for hepatitis C have markedly improved sustained virological response (SVR) rate and might reduce the risk of carcinogenesis of hepatocellular carcinoma (HCC). However, there still remain sporadic reports of HCC emerging after SVR.
By retrospectively studying the clinical courses of resected cases for HCC occurring after obtained SVR, we discuss the clinical factor of SVR in HCC treatment

3. Materials and Methods
121 HCC resections in this 10 years
⇒ 62 resections (51%) are positive for hepatitis C
⇒ 18 resections with interferon treatment history
7 resections (5 patients) with HCC obtained SVR
Analyze the clinical course after resection.

4. Patients Background 4 men, 1 woman
67 years old in average (range 63-74),
All cases were negative for HBsAg,
No history of alcoholic abuse,
Only 1case complicated with diabetes mellitus.

5. Clinical course１： SVR⇒hepatectomy
Case 1：74 y.o、woman
Hepatectomy
①2007
SVR
1996
132 months
48 months
No recurrence
Alive
ICG R %
Case 2:69 y.o、woman
Hepatectomy
①2010
SVR
2004
72 months
12 months
No recurrence
Alive
ICG R15 4.2%
Case 3：63 y.o、man
SVR
2008
Hepatectomy
①2009
Hepatectomy
② 2010
12 months
12 months
12 months
No recurrence
Alive
ICG R15 7.9%
ICG R %

6. Clinical course ２： Hepatectomy⇒SVR⇒hepatectomy
Case 4：64y.o、man
Hepatectomy
①2001
Hepatectomy
②2008
SVR
2003
60 months
34 months
No recurrence
Alive
ICG R15 8.0%
ICG R15 7.8%
Case 5：70y.o、man
Hepatectomy
①2003
Hepatectomy
②2007
Hepatectomy
③2008
SVR
2005
24 months
12 months
ICG R %
ICG R15 8.3%
ICG R15 8.8%
39 months
No recurrence
Alive

7. Repeated resections after SVR
Case 3
Hepatectomy
①2009
Hepatectomy
②2010
SVR
2008
12 months
Partial hepatectomy
of S6
Systematic hepatectomy
of S6

8. Repeated resections after SVR
Case 5
Hepatectomy
①2003
Hepatectomy
②2007
SVR
2005
Hepatectomy
③2008
12 months
Partial hepatectomy
of S8
Partial hepatectomy
of S8

9. Pathological findings of tumors (7 resections)
Number of tumors single 6, two 1
Average size of tumors 19mm (10-24mm)
Vascular invasion /7
Histological findings
Well differentiated type　 cases,
Moderately differentiated type 4 cases,
Poorly differentiated type　 case
Clinical stage
fStage 1 3 cases
fStage 2 4 cases

10. Pathology of resected liver background
Case 1：74y.o、woman
Hepatectomy
①2007
SVR
1996 F4 A2
Case 2:69y.o、woman
Hepatectomy
①2010 F3 A2
SVR
2004
Case 3：63y.o、man
Hepatectomy
①2009 F3 A2
Hepatectomy
②2010 F3 A1
SVR
2008

11. Pathology of resected liver background before and after SVR
Case 4： 64y.o、man
Hepatectomy
①2001
Hepatectomy
②2008
SVR
2003
F2/3 A2
F2/1 A1
Case 5：70y.o、man
Hepatectomy
①2003
Hepatectomy
②2007
Hepatectomy
③2008
SVR
2005 F1 A2 F1 A1 F1 A1

12. Clinical progress and Prognosis
All cases are alive without recurrence since the last hepatectomy.
Average observation period
972 days （range 198～1772 days）.

13. Summary Average time since SVR till carcinogenesis
50.3 months （range months）.
Liver function is well preserved
Average tumor size: 19mm, lesser than fStage2.
Grade of fibrosis showed no change, but activity of hepatitis improved.
Both recurrent HCCs after SVR emerged within the same segment.
All cases are alive without relapse.

14. Discussion Carcinogenic mechanism after obtained SVR
Early HCC existed prior to SVR.
Latent infection of HBV.
Alcoholic hepatitis.
Carcinogenic risk of liver fibrosis itself.
Steatohepatitis.
Systematic hepatectomy is favorable.
Require long term follow up.

15. Conclusions
HCC recurrence may emerge even after hepatectomy in HCV-hepatitis patients obtained SVR.
However, with well preserved liver function, prognosis is good.
Carcinogenesis in SVR cases suggests the possibility that systematic hepatectomy is effective.