title: Prediction of recurrence and extratumor spread of hepatocellular carcinoma following resection.
abstract: OBJECTIVE
  The prognosis of patients with hepatocellular carcinoma (HCC) undergoing hepatectomy depends mostly on tumor recurrence. Portal vein invasion (Vp) and intrahepatic metastasis (IM) might strongly reflect the invasiveness of HCC, but the number of patients in the present series in whom either of these factors were detected was small. In this study, we defined Vp and IM as the extratumor spread, and we focused on the relationship between recurrence in patients after hepatectomy and the extratumor spread and the mitotic activities of cancer cells, in the hope that careful monitoring of recurrence might be possible by simply analyzing histology of the resected specimens.
  
  
  METHODS
  Univariate and multivariate analyses were used to determine the factors potentially related to recurrence in 50 patients who underwent hepatectomy for HCC.
  
  
  RESULTS
  The cumulative recurrence rate at 5 years was 81.0%. In univariate analysis, absence of the extratumor spread, mitotic index of four or less, and curative resection were significantly correlated with low incidence of recurrence. In multivariate analysis, the extratumor spread was the only significant variable influencing recurrence. The mitotic index in HCCs with the extratumor spread was significantly higher than the mitotic index in HCCs without the extratumor spread.
  
  
  CONCLUSIONS
  As a predictive factor for recurrence after resection of HCC, the extratumor spread that reflects the malignant potential of cancer cells was found to be more accurate than is any single invasiveness parameter such as Vp or IM.
authors.affiliation: Department of Surgery, Miyagi Cancer Center Hospital, Natori, Japan. k-ouchi@mcc.pref.miyagi.jp
authors.forename: K
authors.initials: K
authors.lastname: Ouchi
authors.forename: T
authors.initials: T
authors.lastname: Sugawara
authors.forename: T
authors.initials: T
authors.lastname: Fujiya
authors.forename: Y
authors.initials: Y
authors.lastname: Kamiyama
authors.forename: Y
authors.initials: Y
authors.lastname: Kakugawa
authors.forename: J
authors.initials: J
authors.lastname: Mikuni
authors.forename: H
authors.initials: H
authors.lastname: Yamanami
authors.forename: K
authors.initials: K
authors.lastname: Nakagawa
mesh_terms: D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D002455:Cell Division; D005544:Forecasting; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008940:Mitotic Index; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011169:Portal Vein / Q000473:pathology; D011379:Prognosis; D019043:Vascular Neoplasms / Q000473:pathology*