title: Tumor doubling time predicts recurrence after surgery and describes the histological pattern of hepatocellular carcinoma on cirrhosis.
abstract: 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.
authors.affiliation: Dipartimento di Discipline Chirurgiche, Rianimatorie e dei Trapianti, University of Bologna, Policlinico S.Orsola, Via Massarenti 9, 40138 Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.forename: Bruno
authors.initials: B
authors.lastname: Nardo
authors.forename: Roberto
authors.initials: R
authors.lastname: Montalti
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Giuliano
authors.initials: G
authors.lastname: La Barba
authors.forename: Antonino
authors.initials: A
authors.lastname: Cavallari
authors.forename: Luigi
authors.initials: L
authors.lastname: Bolondi
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: 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