title: Clinicopathological features of recurrence in patients after 10-year disease-free survival following curative hepatic resection of hepatocellular carcinoma.
abstract: BACKGROUND
  The present study aimed to clarify the clinicopathologic features of long-term disease-fee survival after resection of hepatocellular carcinoma (HCC).
  
  
  METHODS
  This retrospective study identified 940 patients who underwent curative resection of HCC between 1991 and 2000 at five university hospitals. Seventy-four patients with 10 years of recurrence-free survival were identified and followed up. They were divided into two groups, 60 recurrence-free and 14 with recurrence after a 10-year recurrence-free period.
  
  
  RESULTS
  Overall survival rates of recurrence and non-recurrence groups were 68 and 91 % at 16 years, and 34 and 91 % at 20 years (p = 0.02), respectively. There were five (36 %), and two deaths (3 %), respectively, after 10 recurrence-free years. A second resection for recurrence was performed in four patients (29 %), and mean survival was 15.3 years after the first hepatectomy. Although three patients in the non-recurrence group (5 %) developed esophageal and/or gastric varices, seven patients in the recurrence group (50 %) developed varices during 10 years (p < 0.0001). In multivariate analysis, preoperative and 10-year platelet count was identified as a favorable independent factor for maintained recurrence-free survival after a 10-year recurrence-free period following curative hepatic resection of HCC.
  
  
  CONCLUSIONS
  Recurrence of HCC may occur even after a 10-year recurrence-free period. Long-term follow-up after resection of HCC is important, and should be life-long. Patients with higher preoperative and 10-year platelet counts are more likely to have long-term survival after resection. A low platelet count, related to the degree of liver fibrosis, is a risk factor for recurrence and survival of HCC after curative resection.
authors: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan. kaibori@hirakata.kmu.ac.jp
authors: Masaki
authors: M
authors: Kaibori
authors: Shoji
authors: S
authors: Kubo
authors: Hiroaki
authors: H
authors: Nagano
authors: Michihiro
authors: M
authors: Hayashi
authors: Seiji
authors: S
authors: Haji
authors: Takuya
authors: T
authors: Nakai
authors: Morihiko
authors: M
authors: Ishizaki
authors: Kosuke
authors: K
authors: Matsui
authors: Takahiro
authors: T
authors: Uenishi
authors: Shigekazu
authors: S
authors: Takemura
authors: Hiroshi
authors: H
authors: Wada
authors: Shigeru
authors: S
authors: Marubashi
authors: Koji
authors: K
authors: Komeda
authors: Fumitoshi
authors: F
authors: Hirokawa
authors: Yasuyuki
authors: Y
authors: Nakata
authors: Kazuhisa
authors: K
authors: Uchiyama
authors: A-Hon
authors: AH
authors: Kwon
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome