title: Pre-operative predictors of post-hepatectomy recurrence of hepatocellular carcinoma: can we predict earlier?
abstract: OBJECTIVE
  To determine the predictors for recurrence in patients receiving curative hepatectomy for hepatocellular carcinoma (HCC).
  
  
  METHODS
  From January 2001 to July 2007, all patients having hepatectomy for first occurrence HCC with curative intent were identified from a prospectively collected database. Prognostic factors for recurrence and survival after resection were analyzed.
  
  
  RESULTS
  A total of 235 patients were included. With a median follow-up of 50.2 (0.07-125.1) months, the recurrence rate was 57.0%. The 1-, 3-, and 5-year overall survival rates were 83.9%, 66.0%, and 58.1% respectively. Multivariate analysis demonstrated that multi-focal lesions (HR: 2.93, P < 0.001), alpha-fetoprotein (AFP) level greater than 100 ng/ml (HR: 1.74, P = 0.002) and history of tumor rupture (HR: 2.84, P = 0.003) were independent risk factors for recurrence of HCC after hepatectomy.
  
  
  CONCLUSIONS
  Predictors for HCC recurrence can be identified before operation. These important parameters should be considered before and after contemplating curative resection for HCC patients and for risk stratification in future clinical trials for neoadjuvant or post-resection adjuvant therapy. The possible use of neoadjuvant or adjuvant treatment to improve survival should be addressed by further trials.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region. chongcn@surgery.cuhk.edu.hk
authors.forename: Charing Ching-Ning
authors.initials: CC
authors.lastname: Chong
authors.forename: Kit-fai
authors.initials: KF
authors.lastname: Lee
authors.forename: Philip Ching-Tak
authors.initials: PC
authors.lastname: Ip
authors.forename: Jeff Siu-Wang
authors.initials: JS
authors.lastname: Wong
authors.forename: Sunny Yue-Sun
authors.initials: SY
authors.lastname: Cheung
authors.forename: John
authors.initials: J
authors.lastname: Wong
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Ho
authors.forename: Paul Bo-San
authors.initials: PB
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors