title: Resection of hepatocellular carcinoma without cirrhosis.
abstract: OBJECTIVE
  The aim of this study was to examine the features and outcomes of noncirrhotic patients undergoing resection for hepatocellular carcinoma.
  
  
  BACKGROUND
  Ten percent to 40% of hepatocellular carcinoma cases arise within a noncirrhotic liver parenchyma. Resection is the standard therapy, yet the published resection series from the West are small.
  
  
  METHODS
  From January 1987 to December 2009, our center performed 206 partial liver resections for nonfibrotic or minimally fibrotic (Scheuer stage 0-2) hepatocellular carcinoma. We retrospectively reviewed these cases and performed univariate and multivariate analyses for predictors of long-term outcomes.
  
  
  RESULTS
  Eighty-one patients (39.3%) had chronic hepatitis B infection and 23 patients (11.2%) had chronic hepatitis C. The remaining 83 (39.8%) had no underlying liver disease. Average age was 60.2 years, and 68.4% of the patients were male. Average tumor size was 8.2 cm. Overall survival at 5 years was 46.3%. Recurrence at 5 years was 50.0%. Independent predictors for decreased survival were tumor size larger than 7.0 cm, creatinine more than 1.0 mg/dL, satellite nodules, albumin less than 3.5 gm/dL, alpha-fetoprotein more than 100 ng/mL, and any vascular invasion. Chronic hepatitis B virus infection predicted longer survival. Independent predictors for decreased time to recurrence were albumin less than 3.5 gm/dL, any vascular invasion, age more than 60 years, tumor size larger than 7.0 cm, and alpha-fetoprotein more than 100 ng/mL. Treatment of recurrence with either repeat resection or ablation was associated with a median survival of 50.4 months from time of recurrence.
  
  
  CONCLUSIONS
  Hepatocellular carcinoma can develop in a minimally fibrotic hepatitis C patient. Tumor-related factors such as vascular invasion primarily determine long-term outcomes. Hepatitis B virus-associated tumors seem to have a better prognosis in the nonfibrotic or minimally fibrotic population. Aggressive treatment of recurrence is warranted.
authors.affiliation: Mount Sinai Liver Cancer Program, Mount Sinai Medical Center, New York, NY 10029, USA. brian.shrager@mountsinai.org
authors.forename: Brian
authors.initials: B
authors.lastname: Shrager
authors.forename: Ghalib
authors.initials: G
authors.lastname: Jibara
authors.forename: Myron
authors.initials: M
authors.lastname: Schwartz
authors.forename: Sasan
authors.initials: S
authors.lastname: Roayaie
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis