title: Factors predisposing to poorly differentiated hepatocellular carcinoma and its recurrence.
abstract: OBJECTIVE
  We investigated the clinical factors predisposing moderately or poorly differentiated hepatocellular carcinoma and analyzed which clinical and histological factors are associated with poorly differentiated hepatocellular carcinoma (HCC) recurrence.
  
  
  METHODS
  Percutaneous fine-needle biopsy was taken from the liver tumor of 191 consecutive patients between January 1994 and September 1996. The histological degree of differentiation of hepatocellular carcinoma at the first time of initial treatment and at the time of second recurrence was classified according to the criteria of Edmondson and Steiner.
  
  
  RESULTS
  At the time of the first therapy, 86 patients, 81, 24, and 0 patients had liver tumors classified as Edmondson (Ed), 1, 2, 3, and 4, respectively. The prognosis of patients with Ed-3/4 HCC was worse than and the tumor sizes were larger than that of Ed-1/2 HCC patients. Of the 167 patients classified as Ed-1/2 at the time of first therapy, HCC recurred in 95 of the patients during the mean follow-up period of 3.4 years. Multivariate analysis revealed that only tumor size (P=0.035) and TACE therapy (P=0.0009) were independently significant factors in predicting future Ed-3/4 or multiple HCC recurrence.
  
  
  CONCLUSIONS
  Tumor size and TACE therapy were clinical predisposing factors for Ed-3/4 or multiple HCC recurrences.
authors.affiliation: Department of Gastroenterology, University of Tokyo, Tokyo, Japan. aka8@ta2.so-net.ne.jp
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Akamatsu
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shiratori
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Koike
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Shiina
authors.forename: Takuma
authors.initials: T
authors.lastname: Teratani
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hamamura
authors.forename: Shuntro
authors.initials: S
authors.lastname: Obi
authors.forename: Shinpei
authors.initials: S
authors.lastname: Sato
authors.forename: Ryousuke
authors.initials: R
authors.lastname: Tateishi
authors.forename: Tomonori
authors.initials: T
authors.lastname: Fujishima
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Imai
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000473:pathology* / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D012307:Risk Factors; D016019:Survival Analysis