title: Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy.
abstract: OBJECTIVE
  We conducted a retrospective cohort study to investigate factors to early and late phase recurrence of hepatocellular carcinoma (HCC).
  
  
  METHODS
  The study population consisted of 249 patients including 157 with cirrhosis who underwent hepatectomy for HCC. The endpoint was time-to-recurrence. Using a Cox regression model, factors to early and late phase recurrences were investigated censoring recurrence-free patients at the 2-year time point and in patients without recurrence at 2 years.
  
  
  RESULTS
  Actuarial probability of overall recurrence at 1, 3, and 5 years were 0.301, 0.623, and 0.790, respectively, with a median follow-up of 624 days. Early recurrence was observed in 123 out of 249 patients; while late recurrence was found in 61 out of 113 patients. Factors to early recurrence were as follows: non-anatomical resection, presence of microscopic vascular invasion, and serum alpha-fetoprotein level >or=32 ng/ml. Those contributing to late phase recurrence were higher grade of hepatitis activity, multiple tumors, and gross tumor classification.
  
  
  CONCLUSIONS
  Variables associated with metastatic recurrence were factors to early phase recurrence; whereas those related with elevated carcinogenesis contributed to late phase recurrence, thus providing an epidemiological evidence that different mechanisms, i.e. metastasis and de novo, are involved in intrahepatic recurrence after hepatectomy for HCC.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. himamura-tky@umin.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Matsuyama
authors.forename: Eiji
authors.initials: E
authors.lastname: Tanaka
authors.forename: Takao
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Shinichi
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Masami
authors.initials: M
authors.lastname: Minagawa
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawasaki
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors