title: Prognostic factors and optimal treatment strategy for intrahepatic nodular recurrence after curative resection of hepatocellular carcinoma.
abstract: BACKGROUND
  Intrahepatic recurrence is a major problem after curative resection of hepatocellular carcinoma. However, the most effective treatments for patients with intrahepatic recurrence still remain unclear. In addition, the selection of various treatment modalities such as repeat resection, local ablation therapy, and transarterial chemoembolization is only applicable to patients with intrahepatic nodular recurrence.
  
  
  METHODS
  Of 353 patients who underwent curative resection, 97 patients with intrahepatic nodular recurrence were retrospectively studied. The prognostic factors for survival after recurrence and treatment modalities were analyzed. The patients were divided into two groups, a control group and a progression group, according to their response to initial treatment for recurrent tumors.
  
  
  RESULTS
  The 1-, 3-, and 5-year overall survival rates after recurrence in patients with intrahepatic nodular recurrence were 91.0%, 71.0%, and 37.5%, respectively. Multivariate analysis revealed that early recurrence (< or =12 months), Child-Pugh class B or C at diagnosis of recurrence, and serum albumin level of < or =3.5 g/dL at diagnosis of recurrence were poor prognostic factors for survival after recurrence. With regard to the response to the initial treatment, time to recurrence of < or =12 months was found to be the only statistically significant risk factor for progression of disease in multivariate analysis.
  
  
  CONCLUSIONS
  Time to recurrence, which usually corresponds with the cellular origin of recurrence, seems to be more important when determining the prognosis of patients with recurrent disease and treatment response than treatment modality. Therefore, different treatment methods should be selected according to the time to recurrence of intrahepatic nodular recurrence.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, 134, Shinchon-Dong, Seodaemun-Ku, Seoul 120-752, Korea.
authors.forename: Gi-Hong
authors.initials: GH
authors.lastname: Choi
authors.forename: Dong-Hyun
authors.initials: DH
authors.lastname: Kim
authors.forename: Chang-Moo
authors.initials: CM
authors.lastname: Kang
authors.forename: Kyung-Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Jin-Sub
authors.initials: JS
authors.lastname: Choi
authors.forename: Woo-Jung
authors.initials: WJ
authors.lastname: Lee
authors.forename: Byong-Ro
authors.initials: BR
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D018450:Disease Progression; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors