title: Selection criteria for hepatectomy in patients with hepatocellular carcinoma classified as Child-Pugh class B.
abstract: BACKGROUND
  The appropriate surgical approach for hepatocellular carcinoma (HCC) patients of Child-Pugh class B is unclear. The aim of this study was to clarify the prognostic factors after hepatectomy in Child-Pugh class B patients and to delineate the selection criteria for hepatectomy.
  
  
  METHODS
  One hundred fifty patients of Child-Pugh class B who underwent hepatectomy were enrolled in this retrospective study (Hx group). Univariate and multivariate analyses were performed to identify prognostic factors. The prognosis was compared with that of 23 patients of Child-Pugh class B who underwent liver transplantation (LT group).
  
  
  RESULTS
  The overall survival rate of the Hx group was significantly worse than that of the LT group (5-year survival: 36.0 vs. 78.3%, p = 0.001). In multivariate analyses, diabetes mellitus (p = 0.011), preoperative total bilirubin level ≥ 1.5 mg/dl (p = 0.038), and Child-Pugh score of 8 or 9 (p = 0.038) were independent prognostic factors. Although the overall 5-year survival rate of patients with none of the three adverse prognostic factors was only 50.3%, that of patients with one or more adverse prognostic factors was only 27.2% (p = 0.001).
  
  
  CONCLUSIONS
  Hepatectomy may be the optimal initial treatment for HCC patients classified as Child-Pugh class B and without any adverse prognostic factors.
authors.affiliation: Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Hiroshima, 734-8551, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kuroda
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tashiro
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Akihiko
authors.initials: A
authors.lastname: Oshita
authors.forename: Hironobu
authors.initials: H
authors.lastname: Amano
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
mesh_terms: D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000145:classification* / Q000401:mortality / Q000469:parasitology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods / Q000401:mortality*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome