Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1207-1215
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1207
Optimal duration of the early and late recurrence of hepatocellular carcinoma after hepatectomy
Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Toshiya Ochiai, Eigo Otsuji
Yusuke Yamamoto, Hisashi Ikoma, Ryo Morimura, Hirotaka Konishi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Takeshi Kubota, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Chouhei Sakakura, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan
Toshiya Ochiai, Department of Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan
Author contributions: Yamamoto Y, Ikoma H, Morimura R and Otsuji E designed the research; Yamamoto Y, Ikoma H, Morimura R and Ochiai T performed the research; Yamamoto Y, Konishi H, Murayama Y, Komatsu S, Shiozaki A, Kuriu Y, Kubota T, Nakanishi M, Ichikawa D, Fujiwara H, Okamoto K, Sakakura C and Ochiai T contributed new reagents and analytic tools; Yamamoto Y, Ikoma H, Morimura R and Ochiai T analyzed the data; and Yamamoto Y, Ikoma H and Morimura R wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hisashi Ikoma, MD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 6028566, Japan. ikoma@koto.kpu-m.ac.jp
Telephone: +81-75-2515527 Fax: +81-75-2515522
Received: March 16, 2014
Peer-review started: March 17, 2014
First decision: April 5, 2014
Revised: July 16, 2014
Accepted: September 12, 2014
Article in press: September 16, 2014
Published online: January 28, 2015
Processing time: 316 Days and 18.1 Hours
Abstract

AIM: To determine the best cut-off value between the early and late recurrence periods after the initial recurrence of hepatocellular carcinoma (HCC).

METHODS: The clinical records of 404 patients who underwent macroscopic curative hepatectomy for HCC between 1980 and 2010 were retrospectively examined. We divided the 252 patients experienced a recurrence of HCC into two groups, the early and late recurrence groups using the “minimum P-value” approach. Factors for early recurrence were investigated using all 404 patients, and factors related to late recurrence were investigated in the patients who were confirmed to be recurrence free at the end of the early recurrence period.

RESULTS: For the 252 patients who experienced a recurrence, the optimal cut-off value for differentiating early and late recurrence based on the overall survival after initial recurrence was 17 mo (5-year overall survival after initial recurrence: 15.4% vs 36.3%, P = 0.000018). Cox proportional hazard analysis identified early recurrence (P = 0.003) as one of the independent prognostic factors associated with overall survival after initial recurrence. A logistic regression model showed that an alpha-fetoprotein level > 100 ng/mL (P < 0.001), multiple HCC (P < 0.001), serosal invasion (P = 0.031), and microvascular invasion (P = 0.012) were independent factors associated with early recurrence, whereas the only independent factor related to late recurrence was liver cirrhosis (P = 0.002).

CONCLUSION: Seventeen months after hepatectomy is a useful cut-off value between early and late recurrence of HCC based on the prognosis and different etiologies.

Keywords: Early recurrence; Late recurrence; Hepatocellular carcinoma; Hepatectomy; Minimum P-value approach

Core tip: The optimal cut-off value for differentiating early and late recurrence after hepatectomy for the hepatocellular carcinoma based on the overall survival after initial recurrence was 17 mo, and this cut-off may distinguish recurrences with different etiologies.