title: Chronic schistosomiasis japonica is an independent adverse prognostic factor for survival in hepatocellular carcinoma patients who have undergone hepatic resection: clinicopathological and prognostic analysis of 198 consecutive patients.
abstract: BACKGROUND
  The present study was carried out to clarify the clinicopathological features of hepatocellular carcinoma (HCC) patients with chronic schistosomiasis japonica (SJ) who underwent hepatic resection. Furthermore, we also analyzed the impact of chronic SJ on survival after hepatic resection.
  
  
  METHODS
  During the last 10 years in our department, 198 patients have undergone hepatic resection for HCC. Forty-four patients were diagnosed as having chronic SJ by histological examination. Clinicopathological features and survival were retrospectively analyzed.
  
  
  RESULTS
  Age in the SJ group was significantly higher than in the non-SJ group. In the SJ group, positivity to HBsAg (hepatitis B surface antigen) was significantly lower than in the non-SJ group, and patients more often developed intrahepatic cholangiocellular carcinoma (or cholangiolocellular carcinoma) than in the non-SJ group. Greatest tumor dimension in the SJ group was significantly larger than in the non-SJ group. Univariate analysis revealed that chronic SJ, prothrombin time 80% or less and Child-Pugh B, des-gamma-carboxyprothrombin (DCP) level >40 milli-arbitrary units (mAU)/ml, tumor diameter of more than 5.0 cm, multiple tumors, vascular invasion, intrahepatic metastasis, advanced T stage (T2-4), and non-curative resection were associated with significantly worse overall survival. By multivariate analysis, chronic SJ, Child-Pugh B, advanced T stage, and non-curative resection were independent predictors of the adverse overall survival of HCC patients after hepatic resection.
  
  
  CONCLUSIONS
  Patients with chronic SJ were older, had larger HCC, and were more often complicated by cholangiocellular carcinoma (or cholangiolocellular carcinoma) than non-SJ patients. Chronic SJ was an independent adverse prognostic factor for survival after hepatic resection in HCC patients.
authors.affiliation: First Department of Surgery, Yamanashi University School of Medicine, 1110 Shimokato, Chuo-city, Yamanashi 409-3898, Japan. masam@yamanashi.ac.jp
authors.forename: Masanori
authors.initials: M
authors.lastname: Matsuda
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012554:Schistosomiasis japonica / Q000150:complications*; D016019:Survival Analysis