title: Histopathologic differentiation of the main nodule determines outcome after hepatic resection for synchronous multicentric hepatocellular carcinomas.
abstract: OBJECTIVE
  Clinicopathological features and outcome after surgery in patients with synchronous multicentric hepatocellular carcinoma were examined in relation to the histopathological grade of differentiation of the main nodule.
  
  
  METHODS
  Two hundred and sixty-five patients with synchronous multicentric hepatocellular carcinoma (total, 683 nodules) who had undergone curative hepatectomy from 1988 through 1999 were studied retrospectively. In multicentric occurrences of hepatocellular carcinoma, the tumor with the largest dimension was defined as the main nodule, and the others as accessory nodules.
  
  
  RESULTS
  The histopathological grade of differentiation of the main nodule was assessed to be well differentiated in 72 patients (27.2%), moderately differentiated in 160 patients (60.4%), and poorly differentiated in 33 patients (12.4%). Tumor size of the main nodule was significantly smaller in patients with well differentiated hepatocellular carcinoma than in patients with moderately or poorly differentiated hepatocellular carcinoma. Alpha-fetoprotein levels were significantly lower in cases in which the main nodule was diagnosed to be well differentiated hepatocellular carcinoma than in other cases. The 5-year survival rate and recurrence-free survival rate were significantly greater in cases in which the main nodule showed well differentiated hepatocellular carcinoma (78.1% and 33.8%, respectively) than in other cases [moderately differentiated 49.0% (p<0.0001), 11.6% (P=0.0002); poorly differentiated 37.4% (p<0.0001), 8.3% (P=0.0002), respectively]. Multivariate analysis identified the histopathological grade of the main nodule as significant independent prognostic factors.
  
  
  CONCLUSIONS
  There were differences in surgical outcome in relation to the histopathological grade of differentiation of the main nodule in patients with synchronous multicentric hepatocellular carcinoma.
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. ariizumi@rd6.so-net.ne.jp
authors.forename: Shun-ichi
authors.initials: S
authors.lastname: Ariizumi
authors.forename: Ken
authors.initials: K
authors.lastname: Takasaki
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Takehito
authors.initials: T
authors.lastname: Ohtsubo
authors.forename: Hideo
authors.initials: H
authors.lastname: Katsuragawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Katagiri
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002454:Cell Differentiation; D004396:Coloring Agents; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green