title: Factors associated with recurrence and survival following hepatectomy for large hepatocellular carcinoma: a multicenter analysis.
abstract: BACKGROUND
  Optimal management of large (>5 cm) hepatocellular carcinoma (HCC) remains controversial. We sought to determine the factors associated with recurrence and survival for patients with large HCC following hepatectomy.
  
  
  METHODS
  An analysis of a combined prospective database from two tertiary care centers was performed on consecutive patients who underwent hepatectomy for HCC > 5 cm. Univariate and multivariate analyses were performed to determine factors associated with recurrence, disease-free (DFS) and overall survival (OS).
  
  
  RESULTS
  Seventy-eight patients were identified: 32 (41%) had hepatic fibrosis. Forty-six patients (59%) underwent a major hepatectomy with a morbidity rate of 41% and a mortality rate of 13%. Fibrosis was associated with male gender (P = 0.045), hepatitis C (P = 0.003), higher Child-Pugh (P < 0.0001) and Okuda score (P = 0.002), smaller tumors (6.25 cm vs. 10.5 cm; P < 0.001), positive-margin resection (P = 0.01), and death (P = 0.047). Factors associated with recurrence include tumor multifocality (P = 0.03) and vascular invasion (P = 0.02). Predictors of OS include multifocal tumors (P = 0.05), margin status (P = 0.02), vascular invasion (P = 0.01), and treatment complications (P = 0.004). The median overall DFS and OS were 12 and 20 months, respectively. Fibrosis had no impact on DFS (P = 0.24) or OS (P = 0.20).
  
  
  CONCLUSIONS
  For patients with HCC larger than 5 cm, tumor-related factors predict outcomes and survival.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky 40202, USA.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Schiffman
authors.forename: Charles E
authors.initials: CE
authors.lastname: Woodall
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.forename: Vasili
authors.initials: V
authors.lastname: Egnatashvili
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018570:Risk Assessment; D012307:Risk Factors