title: Early cancer-related death after resection of hepatocellular carcinoma.
abstract: BACKGROUND
  Surgeons have attempted to prevent early cancer-related death after resection of hepatocellular carcinoma to identify risk factors associated with early death from hepatocellular carcinoma recurrence after liver resection.
  
  
  METHODS
  The study group comprised 350 patients who had undergone liver resection for hepatocellular carcinoma between 1997 and 2007. The preoperative risk factors for early death from intrahepatic recurrence (within 1 year after resection) were evaluated.
  
  
  RESULTS
  Fourteen (4%) patients died of intrahepatic recurrence in the first year after resection. Multivariate analyses identified the following risk factors for early cancer-related death: multiple tumors (odds ratio 10.4; 95% confidence interval, 2.42-44.3; P = .002), vascular invasion (odds ratio 10.1; 95% confidence interval 2.07-50; P = .004), serum alpha-fetoprotein level >20 ng/mL (odds ratio 9.52; 95% confidence interval 1.0--84.2; P = .043), and tumor size ≥50 mm (odds ratio 4.80; 95% confidence interval 1.06-21.9; P = .042). Each of these factors was assigned a score of 1 point, and an algorithm was developed to predict the risk of early death. Outcomes did not differ significantly between patients with 3 or 4 points (P = .48) or between those with 1 or 2 points (P = .49). Patients who underwent liver resection could be stratified into the following distinct groups according to the point score and the associated 1-year survival rate and median survival (shown respectively): 0 points, 99%, and not yet; 1 or 2 points, 96%, and 68 months; and 3 or 4 points, 50%, and 12 months) (P < .0001).
  
  
  CONCLUSIONS
  Even if hepatocellular carcinoma is resectable, patients with a score of 3 or 4 points may not be good candidates for liver resection.
authors.affiliation: Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Moriguchi
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Tokio
authors.initials: T
authors.lastname: Higaki
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kimura
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Hisashi
authors.initials: H
authors.lastname: Nakayama
authors.forename: Takao
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Oamu
authors.initials: O
authors.lastname: Aramaki
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000473:pathology; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase