title: Recurrence after liver resection for hepatocellular carcinoma: risk factors, treatment, and outcomes.
abstract: BACKGROUND
  Tumor recurrence remains the major cause of death after curative resection for hepatocellular carcinoma (HCC). The purpose of this study was to identify risk factors for the recurrence of HCC and to examine long-term outcomes after resection.
  
  
  METHODS
  From July 1992 to July 2004, 193 consecutive patients who underwent hepatic resection as primary therapy with curative intent for HCC were included in this single-center analysis. The perioperative mortality rate was 5%. Time to recurrence (disease-free survival) and overall survival were determined by Kaplan-Meier analysis. Demographic, tumor, and treatment characteristics were tested for their prognostic significance by univariate and multivariate analysis with the log-rank test and the Cox proportional hazards model, respectively.
  
  
  RESULTS
  Median overall survival for the entire cohort was 71 +/- 11 months; disease-free survival was 34 months (range, 1-149 months). After a median follow-up time of 34 months, 98 patients (51%) experienced recurrent cancer; initial tumor recurrence was confined to the liver in 86 patients (88%). With the use of multivariate analysis, preoperative vascular invasion detected on radiologic imaging studies; postoperative vascular invasion found on pathologic assessment, and intermediate and poor tumor differentiation and tumor size and number were significant predictors of disease-free survival. Of the 98 patients who had tumor recurrence, 53 patients (54%) underwent additional therapy (ablation, 31 patients; re-resection, 11 patients; transarterial chemoembolization, 8 patients; liver transplantation, 3 patients) with improvement in survival.
  
  
  CONCLUSIONS
  Despite recurrences in >50% of patients, long-term survival can be achieved after resection of HCC. Identification of risk factors, close follow-up evaluation, and early detection are mandatory because recurrences that are confined to the liver may be amenable to treatment with an additional survival benefit.
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada. shahs01@ummhc.org
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cleary
authors.forename: Alice C
authors.initials: AC
authors.lastname: Wei
authors.forename: Ilun
authors.initials: I
authors.lastname: Yang
authors.forename: Bryce R
authors.initials: BR
authors.lastname: Taylor
authors.forename: Alan W
authors.initials: AW
authors.lastname: Hemming
authors.forename: Bernard
authors.initials: B
authors.lastname: Langer
authors.forename: David R
authors.initials: DR
authors.lastname: Grant
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome