title: Milan criteria, multi-nodularity, and microvascular invasion predict the recurrence patterns of hepatocellular carcinoma after resection.
abstract: OBJECTIVE
  This study aims to evaluate the risk factors for tumor recurrence beyond the Milan criteria (MC) for patients with hepatocellular carcinoma (HCC) after surgical resection (SR) in which salvage liver transplantation is relatively contraindicated.
  
  
  METHODS
  A total of 447 patients who underwent SR for HCC were enrolled consecutively. Among them, 248 and 199 patients were within the Milan criteria and beyond the Milan criteria (BMC group), respectively. Overall survival, recurrence, and disease-free survival were analyzed by multivariate analysis.
  
  
  RESULTS
  After a median follow-up of 34.4 months, 130 patients died. Microvascular invasion, higher Edmondson stage of tumor cell differentiation, BMC group, and no anti-viral therapy were associated with poor overall survival. Multi-nodularity, higher Edmondson stage, BMC group, and no anti-viral therapy were independent risk factors for tumor recurrence, while BMC group and no anti-viral therapy were independent risk factors for disease-free survival. The Milan criteria, multi-nodularity, and microvascular invasion were used to stratify the patients into low-, medium-, and high-risk groups for tumor recurrence outside the MC and showed statistical significance (low vs. medium, p = 0.011; low vs. high, p < 0.001; medium vs. high, p = 0.009).
  
  
  CONCLUSIONS
  The combination of the MC, multi-nodularity, and microvascular invasion predict the post-operative recurrence of HCC and may provide a roadmap for further treatment.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201, Shih-Pai Road, Sec. 2, Taipei, 112, Taiwan.
authors.forename: Hung-Hsu
authors.initials: HH
authors.lastname: Hung
authors.forename: Hao-Jan
authors.initials: HJ
authors.lastname: Lei
authors.forename: Gar-Yang
authors.initials: GY
authors.lastname: Chau
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.forename: Wei-Yu
authors.initials: WY
authors.lastname: Kao
authors.forename: Wing-Yiu
authors.initials: WY
authors.lastname: Lui
authors.forename: Wen-Chieh
authors.initials: WC
authors.lastname: Wu
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D019043:Vascular Neoplasms / Q000473:pathology*