title: Poor prognostic factors of hepatectomy in patients with resectable small hepatocellular carcinoma and cirrhosis.
abstract: OBJECTIVE
  Some patients with hepatocellular carcinoma (HCC) at an early stage cannot attain long-term survival after hepatectomy. The aim of the present study was to investigate the poor prognostic factors for hepatectomy in patients with resectable small HCC with cirrhosis.
  
  
  METHODS
  We studied 95 patients with cirrhosis with HCC, which consisted of a single tumor 5 cm or smaller or two or three tumor nodules each 3 cm or less; an absence of extrahepatic metastasis; and an absence of radiological evidence of macroscopic portal vein or hepatic vein invasion. We used Cox's proportional hazard model to identify risk factors associated with prognosis to determine the contra-indications for hepatectomy in patients with resectable small HCC.
  
  
  RESULTS
  Preoperative risk factors were: (1) serum AFP concentration of more than 400 ng/ml; (2) infiltrative-, massive-, or multinodular-type (multiple) HCC; and (3) the presence of intrahepatic metastasis. Patients who had had more than one of the three preoperative risk factors were poor candidates for hepatic resection, with a 4-year survival of 16.3%.
  
  
  CONCLUSIONS
  If patients with resectable small HCC are diagnosed as having more than one of three preoperative risk factors, they should not receive hepatectomy or should be considered for primary liver transplantation as a therapeutic option for HCC.
authors.affiliation: Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Hirokoji-kawaramachi, Kamigyo-ku, 602-8566, Japan. tochiai@koto.kpu-m.ac.jp
authors.forename: Toshia
authors.initials: T
authors.lastname: Ochiai
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Sonoyama
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Chohei
authors.initials: C
authors.lastname: Sakakura
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ueda
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
authors.forename: Hirosumi
authors.initials: H
authors.lastname: Itoi
authors.forename: Akeo
authors.initials: A
authors.lastname: Hagiwara
authors.forename: Hisakazu
authors.initials: H
authors.lastname: Yamagishi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000075202:Contraindications; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors