title: Influence of coexisting cirrhosis on outcomes after partial hepatic resection for hepatocellular carcinoma fulfilling the Milan criteria: an analysis of 293 patients.
abstract: BACKGROUND
  For patients with liver cirrhosis and hepatocellular carcinoma (HCC) satisfying the Milan criteria (single tumor < or =5 cm or 2 or 3 tumors < or =3 cm), orthotopic liver transplantation (OLT) is an effective treatment. Nevertheless, it remains controversial whether OLT is the best treatment strategy for patients with resectable HCC.
  
  
  METHODS
  This study included 293 HCC patients (both with and without cirrhosis) oncologically satisfying the Milan criteria who underwent primary and curative liver resection between 1990 and 2003.
  
  
  RESULTS
  There were 127 noncirrhotic, 129 Child-Pugh A cirrhotic, and 37 Child-Pugh B cirrhotic patients. Five-year survival rates in each population were 81%, 54%, and 28%, respectively. Coexisting cirrhosis, Child-Pugh classification, alpha-fetoprotein value, tumor burden, and vascular invasion by the tumor were identified as significant prognostic factors. Among these factors, coexisting cirrhosis was the most crucial variable by multivariate analysis. During the initial 3 postoperative years, yearly tumor recurrence rate was 22% in cirrhotic patients and 15% in noncirrhotic patients. In cirrhotic patients, the recurrence rate did not decrease even after three years of tumor-free survival post-resection, whereas in noncirrhotic patients the recurrence rate decreased to 9%. Cirrhosis was associated with a higher probability of recurrence exceeding the Milan criteria.
  
  
  CONCLUSIONS
  Hepatic resection offers an acceptable survival result for HCC patients fulfilling the Milan criteria. Coexisting cirrhosis is associated with higher mortality and recurrence rate, possibly due to multicentric carcinogenesis which limits the efficacy of hepatic resection.
authors.affiliation: Department of Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin Sakyo-ku, Kyoto-city, Kyoto, Japan. ko-taura@air.linkclub.or.jp
authors.forename: Kojiro
authors.initials: K
authors.lastname: Taura
authors.forename: Iwao
authors.initials: I
authors.lastname: Ikai
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yasuchika
authors.forename: Akio
authors.initials: A
authors.lastname: Nakajima
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tada
authors.forename: Satoru
authors.initials: S
authors.lastname: Seo
authors.forename: Takafumi
authors.initials: T
authors.lastname: Machimoto
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery*; D002423:Cause of Death; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D019698:Hepatitis C, Chronic / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate