title: Local recurrence is an important prognostic factor of hepatocellular carcinoma.
abstract: OBJECTIVE
  To clarify the importance of complete treatment by PEIT.
  
  
  METHODS
  A total of 140 previously untreated cases of HCC were enrolled in this study from 1988 to 2002. The inclusion criteria were: a solitary tumor less than 4 cm in diameter or multiple tumors, fewer than four in number and less than 3 cm in diameter, without extrahepatic metastasis or vessel invasion. As general principles for the treatment of HCC, the patients underwent transcatheter arterial chemoembolization (TACE) prior to PEIT. After the initial treatment of the patients, ultrasonography and computed tomography were performed, and measurement of serum levels of alpha-fetoprotein (AFP) was determined. When tumor recurrences were detected, PEIT and/or TACE were repeated whenever the hepatic functional reserve of the patient permitted. We then analyzed the variables that could influence prognosis, including tumor size and number, the serum levels of AFP, the parameters of hepatic function (albumin, bilirubin, ALT, hepaplastin test, platelet number, and indocyanine green retention at 15 min (ICG-R15)), combined therapy with TACE, distant recurrence, and local recurrence.
  
  
  RESULTS
  Univariate analysis identified the ICG test, serum levels of AFP and albumin, tumor size and number, and local recurrence, but not distant recurrence, as significant prognostic variables. In multivariate analysis using those five parameters, the ICG test, tumor size, tumor number, and local recurrence were identified as significant prognostic factors. In both univariate and multivariate analyses, the relative risk for the ICG test was the highest, followed by local recurrence.
  
  
  CONCLUSIONS
  We found that local recurrence is an independent prognostic factor of HCC, indicating that achieving complete treatment for HCC on first treatment is important for improving the prognosis of patients with HCC.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka 812-5282, Japan.
authors.forename: Eiichirou
authors.initials: E
authors.lastname: Arimura
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kotoh
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakamuta
authors.forename: Shusuke
authors.initials: S
authors.lastname: Morizono
authors.forename: Munechika
authors.initials: M
authors.lastname: Enjoji
authors.forename: Hajime
authors.initials: H
authors.lastname: Nawata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012307:Risk Factors