title: Comparison of recurrence of hepatocellular carcinoma after resection in patients with cirrhosis to its occurrence in a surveilled cirrhotic population.
abstract: The presence of cirrhosis is the only risk factor that is advocated for recurrence of hepatocellular carcinoma (HCC) 2 years after hepatic resection compared with noncirrhotic control subjects; however, data for cohorts of exclusively patients with cirrhosis are lacking. This study was designed to assess risk factors and annual incidence of early (<2 years) and late (>2 years) recurrence after resection of cirrhosis and to compare these findings with those of patients with cirrhosis enrolled in HCC surveillance programs (HCC occurrence). Data from 204 patients with cirrhosis resected for HCC and 150 surveilled for cirrhosis were retrospectively collected and compared using propensity score matching to overcome biases of nonrandomized study. Risk factors for early recurrence (incidence = 21.8%/year) were higher serum alpha-fetoprotein (AFP) levels, poorly differentiated tumor, and presence of microvascular invasion (P < 0.05). Risk factors for both late recurrence (18.4%/year) and HCC occurrence (3.3%/year) were male gender, older age, and higher serum transaminase levels; multiple primary tumors and higher AFP were additional risk factors for late recurrence and HCC occurrence respectively (P < 0.05). After propensity adjustment, resected patients with less than two risk factors for late recurrence showed an annual incidence of HCC (6.2%/year) similar to that of surveilled patients with > or =2 risk factors (5.8%/year; P = 0.898). Early and late recurrence of HCC for patients with cirrhosis after resection have distinct risk factors. Annual incidence of HCC 2 years or more after resection may be similar to that of general patients because the same risk factors are involved; assessment of these characteristics could be useful in tailoring clinical management.
authors.affiliation: Department of Surgery and Transplantation, University of Bologna, Italy. aleqko@libero.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.forename: Luisa
authors.initials: L
authors.lastname: Benvegnù
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Luigi
authors.initials: L
authors.lastname: Bolondi
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor