title: Predictors of postoperative diffuse intrahepatic recurrence of hepatocellular carcinoma.
abstract: OBJECTIVE
  Diffuse intrahepatic recurrence of hepatocellular carcinoma in the liver remnant carries an extremely poor prognosis compared with other recurrence patterns. We studied the predictors of this type of recurrence.
  
  
  METHODS
  We determined the risk factors for recurrence and predictors of long-term post-recurrence survival using the Cox's proportional hazard model. We divided 106 patients with recurrent intrahepatic hepatocellular carcinoma into 3 groups based on the number of nodules, and compared clinicopathologic features to determine which risk factors were associated with the diffuse intrahepatic recurrence pattern.
  
  
  RESULTS
  An elevated alpha-fetoprotein concentration, invasive nodular- or massive-type hepatocellular carcinoma, intrahepatic metastasis, the presence of macroscopic ductal invasion, and the lack of a capsule predict diffuse intrahepatic pattern of recurrence. Patients who have three or more of these five factors, are poor candidates for hepatic resection because the likelihood of diffuse intrahepatic recurrence is great, and post-recurrence survival is worse than that with solitary or multiple intrahepatic recurrence.
  
  
  CONCLUSIONS
  It is possible to reduce the risks of cancer recurrence at the time of primary resection. It is important to predict the pattern of early diffuse intrahepatic recurrence. In candidates with a poor prognosis, adjuvant therapy or transplantation should be considered.
authors.affiliation: Department of Digestive Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Sonoyama
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ochiai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hironaka
authors.forename: Hisakazu
authors.initials: H
authors.lastname: Yamagishi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D011184:Postoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors