title: Recurrent hepatocellular carcinoma has an increased risk of subsequent recurrence after curative treatment.
abstract: OBJECTIVE
  Local ablation therapy has been shown to be effective for small hepatocellular carcinoma (HCC); however, HCC recurrence is very frequent even after apparently curative treatment. In particular, recurrent HCC may be more prone to subsequent recurrence, although quantitative data are lacking. The aim of this study was to evaluate the difference in the risk for subsequent recurrence, if any, between primary and recurrent cases.
  
  
  METHODS
  A retrospective analysis was conducted of 376 patients with HCC (uninodular and <or=5 cm, or 2-3 nodules each <or=3 cm) who underwent local ablation therapy. There were 207 primary cases (group I), 100 with first recurrence (group II), and 69 with second or later recurrence (group III). After confirming complete ablation, each patient was followed up for recurrence. Risk factors for recurrence-free survival were analyzed using proportional hazard regression.
  
  
  RESULTS
  The median time to recurrence, as estimated by Kaplan-Meier method, was 30 months in group I, 23 months in group II, and 11 months in group III (P < 0.001). Multivariate proportional hazard regression analysis reveled that group (i.e. previous recurrence) was the strongest predictor of subsequent recurrence; compared to group I, group II showed a hazard ratio of 1.456 (P = 0.015) and group III, 3.011 (P < 0.0001). alpha-Fetoprotein level >100 ng/mL, treatment other than radiofrequency ablation, HCV antibody positivity, and tumor multinodularity also remained as significant predictors.
  
  
  CONCLUSIONS
  Hepatocellular carcinoma at second or later recurrence is three times as prone to subsequent recurrence as is primary HCC, when compared with adjustment for other tumor and hepatic factors.
authors.affiliation: Department of Gastroenterology, University of Tokyo, Graduate School of Medicine, Tokyo, Japan.
authors.forename: Noriyo
authors.initials: N
authors.lastname: Yamashiki
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tateishi
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Shiina
authors.forename: Takuma
authors.initials: T
authors.lastname: Teratani
authors.forename: Hideo
authors.initials: H
authors.lastname: Yoshida
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kondo
authors.forename: Takamasa
authors.initials: T
authors.lastname: Oki
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis