Patients with early recurrence of hepatocellular carcinoma have poor prognosis

• Published in: Hepatobiliary & pancreatic diseases international 2017-06, Vol.16 (3), p.279-288
• Main Authors: Kobayashi, Tomoki, Aikata, Hiroshi, Kobayashi, Tsuyoshi, Ohdan, Hideki, Arihiro, Koji, Chayama, Kazuaki
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; beyond the Milan criteria; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Chi-Square Distribution; early recurrence; Endocrinology & Metabolism; Female; Gastroenterology and Hepatology; Hepatectomy - adverse effects; Hepatectomy - mortality; Humans; Kaplan-Meier Estimate; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Logistic Models; Male; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Odds Ratio; Proportional Hazards Models; Retrospective Studies; Risk Factors; small hepatocellular carcinoma; Time Factors; Treatment Outcome; Tumor Burden
• ISSN: 1499-3872
• DOI: 10.1016/S1499-3872(16)60181-9

BACKGROUND： Early recurrence （ER） after hepatic resection （HR） is a poor prognostic factor for patients with hepatocellular carcinoma （HCC）. This study aimed to identify the clinico- pathological features, outcomes, and risk factors for ER after HR for small HCC in order to clarify the reasons why ER is a worse recurrence pattern. METHODS： We retrospectively examined 130 patients who underwent HR for small HCC （___30 mm）. Recurrence was clas- sifted into ER （〈2 years） and late recurrence （LR） （_〉2 years）. The clinicopathological features, outcomes, and risk factors for ER were analyzed by multivariate analysis. RESULTS： ER was observed in 39 patients （30.0%）. The sur- vival rate of the ER group was significantly lower than that of the LR group （P〈0.005）, and ER was an independent prognos- tic factor for poor survival （P=0.0001）. The ER group had a significantly higher frequency （P=0.0039） and shorter interval （P=0.027） of development to carcinoma beyond the Milan criteria （DBMC） compared with the LR group, and ER was an independent risk factor for DBMC （P〈0.0001）. Multi-nodularity, non-simple nodular type, and microvascular invasion were independent predictors for ER （P=0.012, 0.010, and 0.019, respectively）.CONCLUSIONS： ER was a highly malignant recurrence pattern associated with DBMC and subsequent poor survival after HR for small HCC. Multi-nodularity, non-simple nodular type, and microvascular invasion predict ER, and taking these factors into consideration may be useful for the decision of the treatment strategy for small HCC after HR.