title: Perioperative change in white blood cell count predicts outcome of hepatic resection for hepatocellular carcinoma.
abstract: BACKGROUND
  In spite of improvements in surgical management, hepatocellular carcinoma (HCC) still recurs after operation in 60-70% of patients. Therefore, we investigated the relation between perioperative change in white blood cell count (WBC) and tumor recurrence as well as survival in patients with HCC after hepatic resection.
  
  
  METHODS
  Subjects were 53 patients who underwent elective hepatic resection for HCC. We retrospectively examined the relation between perioperative change in WBC and recurrence of HCC as well as overall survival.
  
  
  RESULTS
  Advanced tumor stage and increasing of WBC on postoperative day (POD) 1 were positively associated with worse disease-free survival rate on both univariate and multivariate analysis (P < 0.05). Advanced tumor stage, increasing of WBC on POD 1, and blood transfusion were positively associated with worse overall survival rate on univariate analysis (P < 0.05), while change in WBC was the only independent factor on multivariate analysis (P < 0.05).
  
  
  CONCLUSIONS
  Perioperative change in WBC after elective hepatic resection for HCC is positively associated with recurrence and worse survival.
authors.affiliation: Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan. sheetan@jikei.ac.jp
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.forename: Kenei
authors.initials: K
authors.lastname: Furukawa
authors.forename: Tomonori
authors.initials: T
authors.lastname: Iida
authors.forename: Taro
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Gocho
authors.forename: Shigeki
authors.initials: S
authors.lastname: Wakiyama
authors.forename: Shoichi
authors.initials: S
authors.lastname: Hirohara
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.forename: Toya
authors.initials: T
authors.lastname: Ohashi
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007958:Leukocyte Count; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009369:Neoplasms / Q000601:surgery; D019990:Perioperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome