Tumor doubling time predicts recurrence after surgery and describes the histological pattern of hepatocellular carcinoma on cirrhosis.
OBJECTIVE
Recurrence of hepatocellular carcinoma (HCC) following surgical resection is influenced by parameters detectable on the resection specimen or through a biopsy. The prognostic significance of HCC doubling time (DT) after surgery has never been investigated.


METHODS
We evaluated 62 patients who underwent curative resection of a single HCC on cirrhosis; tumors were assessed before surgery on two subsequent occasions with the same imaging technique allowing the calculation of DT. The influence of tumor DT, clinical and pathological parameters on recurrence-rate and patients survival was assessed with uni- and multivariate analysis. Relationship between DT and pathological features was also analyzed.


RESULTS
Three-year recurrence rate was 32.3% (20 patients): this was significantly higher in the presence of DT shorter than 100 days (58 versus 18% when equal to or longer; P=0.008), microvascular invasion (59 versus 17% when absent; P=0.008) or tumor undifferentiation (54 versus 25% when well/moderately differentiated; P=0.015). DT was the only independent predictor of recurrence (P=0.005). Patients survival was affected by Child-Pugh class only. DT was significantly shorter in tumors with microvascular invasion (P=0.007), undifferentiation (P=0.003) and high alpha-fetoprotein levels (P=0.011).


CONCLUSIONS
DT is easy to estimate and indicates the prognosis of single HCCs prior to liver resection.
Cucchetti
Alessandro
A
Dipartimento di Discipline Chirurgiche, Rianimatorie e dei Trapianti, University of Bologna, Policlinico S.Orsola, Via Massarenti 9, 40138 Bologna, Italy.
Vivarelli
Marco
M
Piscaglia
Fabio
F
Nardo
Bruno
B
Montalti
Roberto
R
Grazi
Gian Luca
GL
Ravaioli
Matteo
M
La Barba
Giuliano
G
Cavallari
Antonino
A
Bolondi
Luigi
L
Pinna
Antonio Daniele
AD
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors