title: Long-term results of liver resection for hepatocellular carcinoma in noncirrhotic liver.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is among the most common malignant neoplasms worldwide. Only few data on HCC in noncirrhotic livers without viral hepatitis in Western countries are available. The purpose of this study was to define the outcomes and potential prognostic factors associated with survival after hepatic resection in patients with HCC in the absence of liver cirrhosis and hepatitis B or C infection.
  
  
  METHODS
  From January 2000 to September 2010, 148 patients without liver cirrhosis and without extrahepatic metastases underwent curative hepatic resection for HCC at the Surgical Department of the Charité, Campus Virchow Klinikum. The outcomes of these patients were retrospectively reviewed. Patients with cirrhosis or severe fibrosis, fibrolamellar HCC, and those positive for hepatitis B or C were excluded.
  
  
  RESULTS
  The cumulative 1-, 3-, 5-, and 7-year survival rates were 75.4%, 54.7%, 38.9%, and 31.8%, respectively. The 1-, 3-, 5-, and 7-year disease-free survival rates were 60.3%, 38.0%, 29.1%, and 18.1%, respectively. In the multivariate analysis, cumulative survival was decreased by patient age, increased operative time, increased preoperative serum gamma-glutamyl transferase (GGT), and tumor stage. In the subgroup with unifocal neoplasms, N0 and R0 status, tumor size >10 cm, and tumor differentiation were highly predictive of lesser survival. Unfavorable survival was observed in patients with multifocal neoplasms, tumor size >10 cm, and/or poor tumor differentiation.
  
  
  CONCLUSIONS
  The current TNM staging system is stratified for survival and recurrence. Extension of the current TNM staging system by grading and more exact differentiation of tumor size may increase its prognostic accuracy for predicting outcome. Preoperative increased serum GGT level could be a new poor prognostic factor.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, Charité-Universitätsmedizin, Berlin, Germany. wladimir.faber@charite.de
authors.forename: Wladimir
authors.initials: W
authors.lastname: Faber
authors.forename: Siamak
authors.initials: S
authors.lastname: Sharafi
authors.forename: Martin
authors.initials: M
authors.lastname: Stockmann
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
authors.forename: Bruno
authors.initials: B
authors.lastname: Sinn
authors.forename: Gero
authors.initials: G
authors.lastname: Puhl
authors.forename: Marcus
authors.initials: M
authors.lastname: Bahra
authors.forename: Maciej B
authors.initials: MB
authors.lastname: Malinowski
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult