title: Liver fibrosis increases the risk of intrahepatic recurrence after hepatectomy for hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) commonly develops in patients with chronic hepatitis. Intrahepatic recurrence after hepatectomy often includes nodules of new tumour in the liver remnant. The aim of this study was to examine hepatitis-related factors that might predict this type of recurrence.
  
  
  METHODS
  The influence of various hepatitis-related factors on intrahepatic recurrence of HCC was studied by multivariate analysis in 138 patients who underwent curative resection and were followed for more than 2 years.
  
  
  RESULTS
  The Cox proportional hazard model showed that histological evidence of fibrosis of the underlying liver was the most significant predictive factor for intrahepatic recurrence (P = 0.001). Serum albumin level was also significantly associated with recurrence (P = 0.038). The relative risks of histological fibrosis and low serum albumin levels were 8.9 and 1.7 respectively. Among tumour-related factors, only tumour size was significantly associated with recurrence (P = 0.017). Major hepatectomy was also an independent risk factor for intrahepatic recurrence (P = 0.004).
  
  
  CONCLUSIONS
  Histological evidence of fibrosis and low serum albumin levels are useful predictors of intrahepatic recurrence after hepatectomy, presumably owing to metachronous multifocal tumour in the liver remnant.
authors.affiliation: First Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan. saihoko@naramed-u.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Ko
authors.forename: H
authors.initials: H
authors.lastname: Kanehiro
authors.forename: M
authors.initials: M
authors.lastname: Hisanaga
authors.forename: M
authors.initials: M
authors.lastname: Nagao
authors.forename: N
authors.initials: N
authors.lastname: Ikeda
authors.forename: Y
authors.initials: Y
authors.lastname: Nakajima
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006505:Hepatitis / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008113:Liver Neoplasms / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D016016:Proportional Hazards Models; D012307:Risk Factors