title: Usefulness of tumor pressure as a prognostic factor in cases of hepatocellular carcinoma where the diameter of the tumor is 3 cm or less.
abstract: BACKGROUND
  The current study was designed to determine the usefulness of pretreatment tumor pressure as a new prognostic factor in patients with small hepatocellular carcinoma (HCC; 3 cm or smaller in diameter).
  
  
  METHODS
  The study included 39 patients with small HCC in whom tumor pressure was determined. They underwent percutaneous ethanol (with Lipiodol) injection therapy (Lp-PEI) or transcatheter arterial embolization (TAE) of the hepatic artery. Tumor pressure was determined percutaneously under ultrasonographic guidance. The factors analyzed were age, gender, mean blood pressure, the presence/absence of antibody to hepatitis C virus (anti-HCV), alcohol abuse, Child's classification, the presence/absence of esophagogastric varices, serum alpha-fetoprotein (AFP) level, tumor size, number of tumors, degree of tumor differentiation, the presence/absence of tumor capsule, tumor pressure, and the method of treatment. Multivariate analysis using Cox proportional hazards model was conducted on the factors that may have affected prognosis (P < 0.25) according to the univariate analysis using a proportional hazards model.
  
  
  RESULTS
  The rates of local and distant recurrence were higher (P < 0.01, P < 0.01, respectively) and the survival rate was lower (P = 0.03) in patients with high tumor pressure than in those with low tumor pressure. Multivariate analysis revealed that tumor pressure (P < 0.01), AFP level (P = 0.01), and age (P = 0.01) were significant predictive factors associated with local recurrence. Tumor pressure (P < 0.01) and AFP level (P < 0.01) were both significantly associated with distant recurrence. The only significant predictive factor associated with survival rate was tumor pressure (P < 0.04).
  
  
  CONCLUSIONS
  The current study revealed that tumor pressure was associated significantly with survival rates after Lp-PEI or TAE in patients with small HCC. There were also significant predictive factors associated with local recurrence, these being tumor pressure, AFP level, and age, and with distant recurrence, namely, tumor pressure and AFP level. Tumor pressure measured before the initial treatment of patients with small HCC may be a useful new prognostic factor.
authors.affiliation: Department of Gastroenterology, Chikushi Hospital, Fukuoka University, 377-1 Ohaza-Zokumyoin, Chikushino-shi, Fukuoka 818-8502, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ueki
authors.forename: Seigo
authors.initials: S
authors.lastname: Sakaguchi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyajima
authors.forename: Nagafusa
authors.initials: N
authors.lastname: Hatono
authors.forename: Keiji
authors.initials: K
authors.lastname: Tohara
authors.forename: Shoichi
authors.initials: S
authors.lastname: Nakabayashi
authors.forename: Tsuneyoshi
authors.initials: T
authors.lastname: Yao
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kokawa
authors.forename: Motoi
authors.initials: M
authors.lastname: Hirano
authors.forename: Makoto
authors.initials: M
authors.lastname: Okumura
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009369:Neoplasms / Q000473:pathology / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011312:Pressure; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins