Predictive factors of advanced recurrence after curative resection of small hepatocellular carcinoma.
BACKGROUND
The tumour recurrence rate after resection is still high even in patients with small hepatocellular carcinoma (HCC). The advanced patterns of recurrence occasionally occur after resection. In this study, we analysed the clinical and histological characteristics of small HCC and evaluated the predictive factors of advanced tumour recurrence.


METHODS
One hundred and sixty-five patients underwent resection of small HCC measuring 3 cm or less in greatest dimension. Patterns of tumour recurrences were classified into advanced recurrence and minor recurrence based on size, number, vascular invasion and extrahepatic metastasis of recurrent tumour. We created a simple index to closely evaluate the malignant potential of small HCC, named alpha-foetoprotein-size ratio index (ASRI).


RESULTS
Overall tumour recurrence was significantly associated with tumour multiplicity (P<0.001) and ASRI (P=0.001). Tumour multiplicity, ASRI and tumour differentiation were independent and significant predictive factors of advanced recurrences. The overall survival rates were lower in the advanced recurrence group than the minor recurrence or the no recurrence group.


CONCLUSIONS
Patients with advanced recurrences have a poor prognosis, although they have undergone curative resection of small HCC. On the other hand, patients with minor recurrences have a relatively good prognosis. ASRI was a useful index to predict advanced recurrence after curative resection of small HCC. The therapeutic management to prevent advanced recurrences is needed.
Hosaka
Tetsuya
T
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan. hosa-p@toranomon.gr.jp
Ikeda
Kenji
K
Kobayashi
Masahiro
M
Hirakawa
Miharu
M
Kawamura
Yusuke
Y
Yatsuji
Hiromi
H
Sezaki
Hitomi
H
Akuta
Norio
N
Suzuki
Fumitaka
F
Suzuki
Yoshiyuki
Y
Saitoh
Satoshi
S
Arase
Yasuji
Y
Kumada
Hiromitsu
H
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000145:classification / Q000473:pathology*; D011237:Predictive Value of Tests; D011859:Radiography; D012307:Risk Factors; D016019:Survival Analysis; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins