title: Resection of hepatocellular carcinoma in patients without cirrhosis.
abstract: BACKGROUND
  Outcomes for patients with hepatocellular carcinoma (HCC) without cirrhosis and factors associated with disease progression remain unclear. The goals of this single-institution study were to define the outcomes for such patients, and to determine factors associated with survival and disease progression.
  
  
  METHODS
  This was a retrospective review of consecutive patients with HCC without cirrhosis who underwent hepatic resection between 1985 and 2003. Survival was estimated by the Kaplan-Meier method and risk factors were identified by Cox proportional hazards models.
  
  
  RESULTS
  A total of 143 patients were enrolled, of whom 29·4 per cent had identifiable risk factors for chronic liver disease. Major resection (at least three segments) was undertaken in 63·6 per cent of patients. The operative mortality rate was 3·5 per cent. Median disease-free survival was 2·4 years. Multivariable analysis revealed presence of multiple tumours as the only independent predictor of tumour recurrence. Median overall survival was 3·3 years. Factors independently associated with decreased overall survival were multiple tumours, high histological grade, perioperative transfusion, male sex and age at least 66 years.
  
  
  CONCLUSIONS
  Patients with HCC but without cirrhosis have acceptable outcomes after resection. Specific risk factors for the development of HCC in these patients have yet to be defined.
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Smoot
authors.forename: D M
authors.initials: DM
authors.lastname: Nagorney
authors.forename: V S
authors.initials: VS
authors.lastname: Chandan
authors.forename: F G
authors.initials: FG
authors.lastname: Que
authors.forename: C D
authors.initials: CD
authors.lastname: Schleck
authors.forename: W S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: M L
authors.initials: ML
authors.lastname: Kendrick
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D012086:Reoperation; D047368:Tumor Burden