title: Radiological prognosticators of hepatocellular carcinoma treated by hepatectomy.
abstract: BACKGROUND
  Hepatectomy is the main curative treatment for hepatocellular carcinoma (HCC), but postoperative long-term survival is poor. Preoperative radiological features of HCC displayed by computed tomography or magnetic resonance imaging could serve as additional prognostic factors. This study aimed to identify preoperative radiological features of HCC that may be of prognostic significance in hepatectomy.
  
  
  METHODS
  Ninety-two patients who underwent hepatectomy for HCC were included in this study. Preoperative radiological features including tumor number, size, location (peripheral, middle, central), portal vein invasion, hepatic vein invasion, and presence of pseudo-capsule were analyzed in relation to survival.
  
  
  RESULTS
  With a median follow-up period of 41.7 months, the 1-, 3- and 5-year overall survival rates were 85%, 65% and 58%, respectively. Univariate analysis showed that portal vein invasion and absence of pseudo-capsule were significant prognostic factors for overall survival, while all the examined radiological features were prognostic factors for disease-free survival. Multivariate analysis for overall survival found no significant factor. On multivariate analysis for disease-free survival, patients who had tumors with portal vein invasion had poorer survival with a hazard ratio of 2.26 (95% CI, 1.05-4.91; P=0.038) and patients with single nodular HCC or pseudo-capsulated HCC had better survival with a hazard ratio of 0.50 (95% CI, 0.27-0.94; P=0.032) and 0.38 (95% CI, 0.14-0.99; P=0.048), respectively.
  
  
  CONCLUSIONS
  Demonstrable pseudo-capsule of HCC and solitary HCC on imaging and absence of portal vein invasion are features associated with better disease-free survival after hepatectomy. These features may guide treatment planning for HCC.
authors.affiliation: Department of Surgery, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
authors.forename: Kevin K W
authors.initials: KK
authors.lastname: Chu
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Kenneth S H
authors.initials: KS
authors.lastname: Chok
authors.forename: Tan To
authors.initials: TT
authors.lastname: Cheung
authors.forename: William W
authors.initials: WW
authors.lastname: Sharr
authors.forename: Albert C Y
authors.initials: AC
authors.lastname: Chan
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D016016:Proportional Hazards Models; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden