Retrospective Study
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World J Gastroenterol. Dec 7, 2014; 20(45): 17132-17140
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.17132
Evaluation of prognostic factors on recurrence after curative resections for hepatocellular carcinoma
Jae Hyun Han, Dong Goo Kim, Gun Hyung Na, Eun Young Kim, Soo Ho Lee, Tae Ho Hong, Young Kyoung You
Jae Hyun Han, Dong Goo Kim, Gun Hyung Na, Eun Young Kim, Soo Ho Lee, Tae Ho Hong, Young Kyoung You, Department of Surgery, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul 137-701, South Korea
Author contributions: Han JH contributed to data analysis and interpretation, writing the article; Kim DG contributed to conception and design, critical revision of the article; Na GH, Hong TH and You YK contributed to data analysis and interpretation; Kim EY and Lee SH contributed to data collection.
Correspondence to: Dong Goo Kim, MD, Department of Surgery, The Catholic University of Korea, Seoul St. Mary’s Hospital, 222 Banpo-daero, Seocho-gu, Seoul 137-701, South Korea. kimdg@catholic.ac.kr
Telephone: +82-2-22586102 Fax: +82-2-5952992
Received: March 14, 2014
Revised: May 16, 2014
Accepted: July 22, 2014
Published online: December 7, 2014
Processing time: 271 Days and 4 Hours
Abstract

AIM: To select appropriate patients before surgical resection for hepatocellular carcinoma (HCC), especially those with advanced tumors.

METHODS: From January 2000 to December 2012, we retrospectively analyzed the medical records of 298 patients who had undergone surgical resections for HCC with curative intent at our hospital. We evaluated preoperative prognostic factors associated with histologic grade of tumor, recurrence and survival, especially the findings of pre-operative imaging studies such as positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI). And then, we established a scoring system to predict recurrence and survival after surgery dividing the patients into two groups based on a tumor size of 5 cm.

RESULTS: Of the 298 patients, 129 (43.3%) developed recurrence during the follow-up period. The 5 year disease free survival and overall survival were 47.0% and 58.7% respectively. In multivariate analysis, a serum alpha-fetoprotein (AFP) level of > 100 ng/mL and a standardized uptake value (SUV) of PET-CT of > 3.5 were predictive factors for histologic grade of tumor, recurrence, and survival. Tumor size of > 5 cm and a relative enhancement ratio (RER) calculated from preoperative MRI were also significantly associated with prognosis in univariate analysis. We established a scoring system to predict prognosis using AFP, SUV, and RER. In those with tumors of > 5 cm, it showed predicted both recurrence (P = 0.005) and survival (P = 0.001).

CONCLUSION: The AFP, tumor size, SUV and RER are useful for prognosis preoperatively. An accurate prediction of prognosis is possible using our scoring system in large size tumors.

Keywords: Carcinoma; Hepatocellular; Hepatectomy; Prognostic factor; Survival; Recurrence

Core tip: Tumor recurrence after surgical resection for hepatocellular carcinoma is an obstacle to long-term survival. Thus, selection of appropriate patients is important, especially those with advanced tumors. Several factors responsible for the high recurrence and poor survival rates after surgical resection have been described. We evaluate the preoperative clinical factors such as serum alpha fetoprotein, protein induced by vitamin K absence or angiotensin-II and the findings of pre-operative imaging studies such as positron emission tomography-computed tomography and magnetic resonance imaging. And then, we established a scoring system to predict recurrence and survival after surgery.