title: Appropriate surgical management of small hepatocellular carcinomas in patients infected with hepatitis C virus.
abstract: We investigated the incidence of recurrence after resection of small hepatocellular carcinomas (HCC) in patients infected with hepatitis C virus (HCV) to determine the appropriate surgical management of these patients. Sixty-one patients with anti-HCV antibody who underwent curative liver resection for small HCC (<or= 2.0 cm in greatest diameter) were categorized into two groups. Group 1 consisted of 27 patients with serum concentrations of type IV collagen 7S domain (7S collagen), a marker for hepatic fibrosis, < 8 ng/ml. Group 2 consisted of 34 patients with serum concentrations of 7S collagen >or= 8 ng/ml. Serum concentration of 7S collagen correlated with the severity of active hepatitis and the degree of fibrosis in the noncancerous hepatic tissue, both of which are related to risk potential of hepatocarcinogenesis. Serum concentration of total bilirubin, aspartate aminotransferase activity, indocyanine green retention rate at 15 minutes, the proportion of patients who were Child-Pugh class B, and the proportion of patients with severe active hepatitis or cirrhosis (determined by histologic examination) were significantly higher in group 2 than in group 1. Platelet count was significantly lower in group 2. Tumor-free survival rates were not different between the groups. In group 1, nonanatomic resection was a risk factor for recurrence by univariate and multivariate analyses (odds ratio = 3.45, p = 0.040). In group 2, nonanatomic resection was not a risk factor for recurrence. In patients with small HCV-related HCC, anatomic resection is recommended when the serum concentration of 7S collagen is low (< 8 ng/ml) because the potential of hepatocarcinogenesis may be low even after the operation.
authors.affiliation: Department of Gastroenterological and Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan. m7696493@msic.med.osaka-cu.ac.jp
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.forename: Tadashi
authors.initials: T
authors.lastname: Taukamoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hirohashi
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Taichi
authors.initials: T
authors.lastname: Shuto
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kawai
authors.forename: Kenichi
authors.initials: K
authors.lastname: Wakasa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D024141:Collagen Type IV / Q000097:blood; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000097:blood / Q000209:etiology; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D024141:Collagen Type IV