title: Clonality analysis for multicentric origin and intrahepatic metastasis in recurrent and primary hepatocellular carcinoma.
abstract: OBJECTIVE
  To clarify the incidence of multicentric occurrence (MO) and intrahepatic metastasis (IM) for hepatocellular carcinoma (HCC) related to hepatitis B virus in China and to identify the differences between them.
  
  
  METHODS
  Histopathologic and genetic features of primary and recurrent tumors in 160 cases with HCC were analyzed. The two groups, the origin of which was definitely determinable as of multicentric occurrence or as of intrahepatic metastasis, were analyzed for their disease-free survival and clinicopathological differences.
  
  
  RESULTS
  According to histopathological findings, 27.5% and 59.4% patients were considered to be MO and IM, respectively. By comparing the genetic information of loss of heterozygosity and microsatellite instability for 10 different markers between primary and recurrent tumor, 30.0% and 63.8% patients with recurrent HCC were considered to be MO and IM, respectively. In total, 126 cases with unanimous conclusions from the histopathological and genetic method were selected and divided into the MO group (37 cases) and the IM group (89 cases). Analysis of stepwise regression identified that recurrence time, grading, portal vein invasion, tumor number, and Child's stage were the most important discriminating factors between MO and IM (p < 0.05). As for their prognosis, Kaplan-Meier and log rank test showed that the disease-free survival in the MO group was significantly better than in the IM group (p = 0.002).
  
  
  CONCLUSIONS
  Combined analysis of histopathological and genetic analysis may reflect more exactly the nature of recurrent HCC. The incidence of MO in China is lower than in other countries--30% compared to up to 50% in Japan [Morimoto et al., Journal of Hepatology 39:215-221, 2003; Yamamoto et al., Hepatology 29;1446-1452, 1999]. Recurrence time, tumor grading, portal vein invasion, tumor number, and Child's stage are the most important discriminating factors between MO and IM. The prognosis (disease-free survival) of patients with MO compared to IM is significantly better.
authors.affiliation: Department of Hepatobiliary Surgery, Cancer Hospital of Tianjin Medical University, Huanhu Western Road, Hexi District, Tianjin, 300060, People's Republic of China. jianwang04@yahoo.com.cn
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Juzi
authors.forename: Yan
authors.initials: Y
authors.lastname: Sun
authors.forename: Hong
authors.initials: H
authors.lastname: Zheng
authors.forename: Yunlong
authors.initials: Y
authors.lastname: Cui
authors.forename: Haixin
authors.initials: H
authors.lastname: Li
authors.forename: Xishan
authors.initials: X
authors.lastname: Hao
mesh_terms: D000328:Adult; D017677:Age Distribution; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000235:genetics* / Q000556:secondary / Q000821:virology; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000453:epidemiology / Q000235:genetics* / Q000473:pathology* / Q000821:virology; D019656:Loss of Heterozygosity; D008297:Male; D018895:Microsatellite Repeats; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000235:genetics* / Q000473:pathology*; D009367:Neoplasm Staging; D016133:Polymerase Chain Reaction; D011336:Probability; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis