title: Analysis of prognostic factors affecting survival after initial recurrence and treatment efficacy for recurrence in patients undergoing potentially curative hepatectomy for hepatocellular carcinoma.
abstract: BACKGROUND
  Survival analysis in patients with initial recurrence after curative hepatectomy for hepatocellular carcinoma (HCC) has not been well evaluated. In addition, selections of the most effective treatments for patients with recurrent HCC still remain controversial.
  
  
  METHODS
  Three hundred and nineteen patients who underwent potentially curative hepatectomies were followed for initial recurrence, and factors predictive of recurrence were determined. The factors affecting survival including pattern of recurrence and treatment modalities from the time of initial recurrence in 211 patients were retrospectively analyzed.
  
  
  RESULTS
  The overall 5-year disease-free survival rate of 319 patients was 31.1%. The 5-year survival rate of 211 patients from the time of initial recurrence was 31.9%. In a multivariate analysis, a low indocyanine green retention rate, lack of liver cirrhosis, a long interval before recurrence, the absence of portal vein invasion, and intrahepatic recurrence (<or=3 nodules) were shown to be significantly favorable prognostic factors after the initial recurrence. The 5-year survival rate of patients with intrahepatic recurrence (<or=3 nodules) was 42.3%, and no survival differences were observed among different treatment modalities.
  
  
  CONCLUSIONS
  When the initial recurrence occurred after a longer interval, and/or with three or fewer intrahepatic recurrent nodules, a favorable prognosis could be expected in those patients with better liver function and no portal vein invasion at the time of the primary hepatectomy. It is important to conduct a randomized controlled trial to clarify a method for selecting optimal treatment in patients with a smaller number of initial intrahepatic recurrences.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan. kshimada@ncc.go.jp
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Minoru
authors.initials: M
authors.lastname: Esaki
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
authors.forename: Chigusa
authors.initials: C
authors.lastname: Morizane
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ikeda
authors.forename: Hideki
authors.initials: H
authors.lastname: Ueno
authors.forename: Takuji
authors.initials: T
authors.lastname: Okusaka
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Arai
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takayasu
mesh_terms: D051722:ADAM Proteins / Q000032:analysis; D000072198:ADAM17 Protein; D000368:Aged; D000792:Angiography / Q000379:methods; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins; D051722:ADAM Proteins; D000072198:ADAM17 Protein