BACKGROUND: Sometimes patients experience an unexpected fulminant recurrence after partial hepatic resection for the treatment of hepatocellular carcinoma, and this carries a dismal prognosis. We conducted this retrospective study to investigate the risk factors of early multinodular (ie, 10 nodules within 6 months of surgery) recurrence in hepatocellular carcinoma. METHODS: The study population consisted of 409 patients who underwent curative hepatic resection between January 2000 and April 2003. Patients were divided into 3 groups: nodular (<10 nodules) recurrence, multinodular (> or =10 nodules) recurrence, and no recurrence within the 6-month postoperative period. Twenty-six clinicopathologic and surgical variables were subject to univariate and multivariate analysis. RESULTS: According to univariate analysis, the risk factors for early multinodular recurrence in HCC were microvascular tumor emboli, portal vein tumor thrombi, intrahepatic metastases, high Edmonson-Steiner classification, lack of tumor capsule formation, increased alpha-fetoprotein concentration, and tumor size. Of these factors, intrahepatic metastases and portal vein thrombi proved to be significant predictive factors of multinodular recurrence by multivariate analysis. COMMENTS: Postoperative early multinodular recurrence was found to be related to portal vein tumor thrombi and intrahepatic metastases. Accordingly, an effective adjuvant therapeutic modality should be made available for patients with these risk factors.
BACKGROUND: Sometimes patients experience an unexpected fulminant recurrence after partial hepatic resection for the treatment of hepatocellular carcinoma, and this carries a dismal prognosis. We conducted this retrospective study to investigate the risk factors of early multinodular (ie, 10 nodules within 6 months of surgery) recurrence in hepatocellular carcinoma. METHODS: The study population consisted of 409 patients who underwent curative hepatic resection between January 2000 and April 2003. Patients were divided into 3 groups: nodular (<10 nodules) recurrence, multinodular (> or =10 nodules) recurrence, and no recurrence within the 6-month postoperative period. Twenty-six clinicopathologic and surgical variables were subject to univariate and multivariate analysis. RESULTS: According to univariate analysis, the risk factors for early multinodular recurrence in HCC were microvascular tumor emboli, portal vein tumor thrombi, intrahepatic metastases, high Edmonson-Steiner classification, lack of tumor capsule formation, increased alpha-fetoprotein concentration, and tumor size. Of these factors, intrahepatic metastases and portal vein thrombi proved to be significant predictive factors of multinodular recurrence by multivariate analysis. COMMENTS: Postoperative early multinodular recurrence was found to be related to portal vein tumor thrombi and intrahepatic metastases. Accordingly, an effective adjuvant therapeutic modality should be made available for patients with these risk factors.
Authors: Honsoul Kim; Mi-Suk Park; Young Nyun Park; Hyunki Kim; Kyung Sik Kim; Jin Sub Choi; Sang Hoon Ahn; Kwang-Hyub Han; Myeong-Jin Kim; Ki Whang Kim Journal: Yonsei Med J Date: 2009-12-18 Impact factor: 2.759