Korean J Hepatobiliary Pancreat Surg.  2015 Aug;19(3):89-97. 10.14701/kjhbps.2015.19.3.89.

A comparison of the risk factors of intrahepatic recurrence, early recurrencen, and multiple recurrences after resection for single nodular hepatocellular carcinoma

• An HJ
• Shin WY
• Lee KY
• Ahn SI

• KMID: 2043283
• DOI: http://doi.org/10.14701/kjhbps.2015.19.3.89

Abstract

BACKGROUNDS/AIMS
Intrahepatic recurrence is one of the most important causes of compromised prognosis after surgical resection of hepatocellular carcinoma (HCC). This retrospective study was designed to identify and compare the risks of recurrence, early recurrence and multiple recurrences in a single patient population.
METHODS
A series of 92 consecutive patients, who received resection for single nodular HCC at our institute from January 2007 to December 2013, were enrolled in this study. The patients were divided into recurrent and non-recurrent groups; the recurrent group was further divided into subgroups by applying two criteria: early and late recurrence (with a cutoff of 18 months), and single and multiple (> or =2) recurrence. The potential risk factors were compared using univariate and multivariate analyses. The subgroup analysis was performed to determine the effects of different cut-off values on the analysis.
RESULTS
41 recurrences (44.6%) occurred during a mean follow-up of 42.4 months. The Child-Pugh score, and the portal vein invasion were found to be independent risk factors of recurrence, but differentiation was the only independent risk factor of early recurrence. The serum alpha-fetoprotein, tumor size, tumor necrosis, and hemorrhage were found to be the risk factors of multiple recurrences according to the univariate analysis, but lacked significance according to the multivariate analysis. When the cutoffs for early and multiple recurrences were changed to < or =10 months and >3 nodules, respectively, different risk factors were identified.
CONCLUSIONS
Our results implicated that different factors can predict the recurrence, timing, and multiplicity of an HCC recurrence. Further studies should be conducted to prove the complex relationships between tumor burden, invasiveness, and underlying liver cirrhosis for initial tumors, and the timing and multiplicity of recurrent HCC.

Keyword

Risk factors; Recurrence pattern; Hepatocellular carcinoma; Resection

MeSH Terms

alpha-Fetoproteins
Carcinoma, Hepatocellular*
Follow-Up Studies
Hemorrhage
Humans
Liver Cirrhosis
Multivariate Analysis
Necrosis
Portal Vein
Prognosis
Recurrence*
Retrospective Studies
Risk Factors*
Tumor Burden
alpha-Fetoproteins

Figure

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  Fig. 1 Comparison of postoperative recurrence-free survival curves, according to the pathological tumor staging.

• 

  Fig. 2 Comparison of postoperative recurrence-free survival curves, between groups of single versus multiple recurrent nodules (A), and fewer (≤3) versus diffuse (>3) recurrent nodules (B).

• 

  Fig. 3 Distribution of the number of recurrent tumor nodules in the 41 patients with HCC recurrence.

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