Liver resection for early hepatocellular cancer: Comparison of centers in 3 different countries

Table 1 Characteristics of resected stage 1 and 2 hepatocellular cancer patients: Honolulu, Tokyo and Shanghai

Characteristic	Honolulu (n = 146) n (%)	Tokyo (n = 250) n (%)	Shanghai (n = 177) n (%)	P value
Mean age in years	62.7 (SD 11.4)	67.0 (SD 8.7)	50.6 (SD11.1)	< 0.0001
Age < 50 yr	18 (12.3)	8 (3.2)	83 (46.9)	< 0.0001
Males	100 (68.5)	180 (72.0)	145 (81.9)	0.01
Hepatitis B positive	62 (42.5)	35 (14.3)	167 (94.4)	< 0.0001
Hepatitis C positive	39 (26.7)	163 (66.8)	5 (3.3)	< 0.0001
Hepatitis B and C positive	5 (3.4)	4 (1.6)	3 (2.0)	0.50
Stage 1	129 (88.4)	68 (27.2)	91 (51.4)	< 0.0001
Childs A	143 (99.3)	224 (89.6)	172 (97.2)	< 0.0001
Cirrhosis	60 (41.1)	133 (56.8)	163 (92.6)	< 0.0001
Mean tumor size (cm)	6.4 (SD 4.6)	3.0 (SD 2.1)	3.9 (SD 2.6)	< 0.0001
Tumor size < 5.0 cm	75 (51.4)	213 (85.2)	137 (77.4)	< 0.0001
AFP < 20 ng/mL	72 (49.3)	144 (57.6)	70 (39.6)	0.0011
Albumin < 3.5 g/dL	23 (15.8)	85 (34)	21 (11.9)	< 0.0001

Hepatitis B surface (n = 6); hepatitis C virus (n = 32); Child-Pugh (n = 2); cirrhosis (n = 17); albumin n = 17). AFP: Alpha fetal protein.

Table 2 Overall age-adjusted survival in resected stage 1 and 2 hepatocellular cancer patients: Honolulu, United States, Tokyo, Japan and Shanghai, China

Center		Honolulu	Tokyo	Shanghai
No. patients		146	250	177
No. deaths		29	17	6
Mean follow-up (yr)		4.04	3.75	3.55
Median follow-up (yr)		3.33	2.83	4.36
1-yr survival	Hazard ratio1	1	0.28	0.63
	95%CI	Reference	0.15-0.51	0.32-1.21
	P value		< 0.0001	0.17
5-yr survival	Hazard ratio	1	0.7	0.74
	95%CI	Reference	0.50-0.98	0.51-1.09
	P value		0.04	0.13

¹Age-adjusted.

Table 3 Predictors of 1-year and 5-year overall mortality in resected stage 1 and 2 hepatocellular cancer patients in Honolulu, Tokyo and Shanghai

Covariates	Univariate			Multivariate
	Hazard ratio	Confidence interval	P value	Hazard ratio1	Confidence interval	P value
1-yr
Age (yr, ≥ 50 vs < 50)	1.29	0.66-2.55	0.46	1.41	0.68-2.92	0.36
Sex (male vs female)	1.39	0.82-2.38	0.22
AFP (ng/mL, ≥ 20 vs < 20)	2.28	1.33-3.91	0.003	2.27	1.32-3.90	0.003
Cirrhosis (yes vs no)	1.13	0.65-1.95	0.66
Tumor size (cm, ≥ 5 vs < 5)	2.64	1.60-4.34	0.0001	2.00	1.17-3.43	0.01
Albumin (g/dL, < 3.5 vs≥ 3.5)	1.72	1.01-2.94	0.045	2.10	1.20-3.68	0.01
AJCC stage (2 vs 1)	0.90	0.55-1.49	0.16
Childs Pugh (B vs A)	1.27	0.46-3.49	0.64
Hepatitis B (+ vs -)	0.77	0.47-1.28	0.33
Hepatitis C (+ vs -)	0.73	0.42-1.25	0.25
Tokyo vs Honolulu	0.32	0.17-0.58	0.0002	0.33	0.17-0.65	0.001
Shanghai vs Honolulu	0.43	0.23-0.78	0.005	0.54	0.28-1.03	0.06
5-yr
Age (yr, ≥ 50 vs < 50)	1.12	0.79-1.60	0.52	1.14	0.77-1.69	0.53
Sex (male vs female)	1.14	0.84-1.56	0.40
AFP (ng/mL, ≥ 20 vs < 20)	1.56	1.17-2.06	0.002	1.57	1.17-2.10	0.002
Cirrhosis (yes vs no)	1.32	0.97-1.80	0.08	1.59	1.12-2.26	0.009
Tumor size (cm, ≥ 5 vs < 5)	1.66	1.24-2.23	0.0007	1.84	1.34-2.54	0.0002
Albumin (g/dL, < 3.5 vs≥ 3.5)	1.91	1.41-2.58	< 0.0001	1.72	1.21-2.46	0.003
AJCC stage (2 vs 1)	1.30	0.98-1.72	0.07
Childs Pugh (B vs A)	1.78	1.05-3.02	0.03	1.33	0.73-2.43	0.35
Hepatitis B (+ vs -)	0.87	0.65-1.15	0.31
Hepatitis C (+ vs -)	1.11	0.83-1.49	0.48
Tokyo vs Honolulu	0.74	0.53-1.03	0.08	0.51	0.33-0.78	0.002
Shanghai vs Honolulu	0.66	0.46-0.94	0.02	0.47	0.31-0.72	0.0006

¹Multivariate model adjusted for covariates listed. AFP: Alpha fetal protein; AJCC: American Joint Commission on Cancer.