title: Preoperative predictors of survival after resection of small hepatocellular carcinomas.
abstract: OBJECTIVE
  To determine preoperative predictors of survival that can guide the choice of treatment for patients with small hepatocellular cancers (HCCs).
  
  
  BACKGROUND
  The treatment of patients with small (</=5 cm in diameter) HCCs is controversial.
  
  
  METHODS
  A cohort of 249 patients (69 women, 180 men; median age 62 years) who underwent resection with curative intent for small HCC was identified from a multiinstitutional database. For each patient, the clinical data and pathology slides were reviewed. Six clinical factors (age, gender, preoperative alpha-fetoprotein level, hepatitis serology, number of tumors [single vs. multiple], and Child-Pugh score) and three pathologic factors (hepatitis activity score, fibrosis score, and Edmondson-Steiner tumor grade) that can be determined before surgery were correlated with survival. Log-rank tests and Cox proportional hazards modeling were used to determine factors influencing survival.
  
  
  RESULTS
  The median overall survival for the entire cohort was 4.2 years. The estimated overall 5- and 8-year survival rates were 41.1% and 19.8%, respectively. Multivariate Cox analysis indicated that fibrosis score, Edmondson-Steiner grade, and Child-Pugh score were simultaneously significant predictors of survival after resection. A prognostic scoring system based on these covariates was derived and applied to the entire cohort. Patients lacking all three risk factors were assigned a score of 1, patients with one risk factor were assigned a score of 2, and patients with two or three risk factors were assigned a score of 3. Pairwise log-rank tests indicated significant differences in survival between scores 1 and 2, scores 2 and 3, and scores 1 and 3. This scoring system retained its prognostic significance when a subset of 98 patients with positive hepatitis C serology was analyzed separately.
  
  
  CONCLUSIONS
  Patients with small HCCs who will derive the least benefit from resection can be identified before surgery using a score based on tumor grade and the severity of underlying liver disease. In these patients, transplantation and/or ablation should be considered as possible alternative therapies.
authors: International Cooperative Study Group on Hepatocellular Carcinoma: Department of Surgical Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors: Jeffrey D
authors: JD
authors: Wayne
authors: Gregory Y
authors: GY
authors: Lauwers
authors: Iwao
authors: I
authors: Ikai
authors: Dorota A
authors: DA
authors: Doherty
authors: Jacques
authors: J
authors: Belghiti
authors: Yoshio
authors: Y
authors: Yamaoka
authors: Jean-Marc
authors: JM
authors: Regimbeau
authors: David M
authors: DM
authors: Nagorney
authors: Kim-Anh
authors: KA
authors: Do
authors: Lee M
authors: LM
authors: Ellis
authors: Steven A
authors: SA
authors: Curley
authors: Raphael E
authors: RE
authors: Pollock
authors: Jean-Nicolas
authors: JN
authors: Vauthey
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis