title: Factors associated with early recurrence after resection for hepatocellular carcinoma and outcomes.
abstract: BACKGROUND
  Early recurrence (ER) (<1 year) after liver resection is one of the most important factors that impact the prognosis of patients with hepatocellular carcinoma (HCC). We sought to determine factors associated with ER of HCC and examine the outcomes thereafter.
  
  
  METHODS
  From March 2001 to June 2003, 56 patients underwent hepatic resection for HCC at University of Toronto and were prospectively followed with median followup of 24 months. Patients with ER were compared with those who remained disease free for more than 1 year. Patient characteristics, tumor stage, and operative procedures were evaluated for their prognostic significance by univariate and multivariable analysis. Time to recurrence and time to death were analyzed using Kaplan-Meier survival curves and compared using log-rank analysis.
  
  
  RESULTS
  The initial procedure in all patients was surgical hepatectomy. ER occurred in 21 patients (38%), 31 (55%) remained disease free for more than 1 year, and 4 (7%) were omitted from evaluation because of early (<30 days) death. Median survival after initial hepatic resection for those with ER was 27 months, and 2-year survival was 54%. There were no deaths in the group that remained disease free for more than 1 year (100% 2-year survival, p < 0.05). By multivariate analysis, vascular invasion and positive microscopic margins were significant predictors when all 4 variables were considered in the model (p < 0.05). After ER, 11 of 21 patients (52%) underwent additional therapy with significant improvement in median survival (33 months) compared with those not eligible for conventional therapy (18 months, p = 0.05).
  
  
  CONCLUSIONS
  ER after liver resection for HCC is the leading cause of death during the first 2 years after potentially curative resection. ER will develop in approximately 75% of patients with either vascular invasion or positive margins. For patients with these predictive factors additional treatment might be advised.
authors.affiliation: Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada. shimul.shah@uhn.on.ca
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cattral
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.forename: Robin D
authors.initials: RD
authors.lastname: Kim
authors.forename: Bryce R
authors.initials: BR
authors.lastname: Taylor
authors.forename: David R
authors.initials: DR
authors.lastname: Grant
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D018579:Patient Selection; D012307:Risk Factors; D013997:Time Factors