title: Infection with hepatitis C virus is an adverse prognostic factor after liver resection for early-stage hepatocellular carcinoma: implications for the management of hepatocellular carcinoma eligible for liver transplantation.
abstract: BACKGROUND
  Recent data support liver resection (LR) as first-line approach in patients with preserved liver function who have resectable/transplantable hepatocellular carcinoma (HCC). This study was designed to evaluate the outcome of LR in patients with transplantable HCC.
  
  
  METHODS
  Between 1998 and 2009, 75 patients (65 men, mean age 61 ± 11 years) with HCC eligible for liver transplantation (LT) underwent LR. The underlying hepatic disease was related to hepatitis C (HCV) in 30 (40 %) patients, hepatitis B (HBV) in 15 (20 %) patients, alcohol abuse in 26 patients (36 %) and other in 10 patients (13 %). Fifty-five (73 %) patients had cirrhosis. Intermittent clamping of the hepatic pedicle was used in 41 (55 %) patients. Treatment of recurrence by salvage LT was performed in 6 (8 %) patients.
  
  
  RESULTS
  Operative morbidity and mortality rates were 37 and 5 % respectively. At 1, 3, and 5 years, overall (OS) and disease-free (DFS) survival rates were 81, 69,55 and 56, 31, and 21 %, respectively. On multivariate analysis, HCV infection was the only independent factor associated with decreased OS (p = 0.02). On multivariate analysis, HCV infection (p = 0.05) and intermittent hepatic pedicle clamping (p = 0.003) were associated with decreased DFS. The 1-, 3-, and 5-year OS and DFS rates in patients with HCV-related HCC were 69, 53, 38 and 50, 18, and 9% respectively.
  
  
  CONCLUSIONS
  Overall and disease-free survival after liver resection in patients with HCV-related HCC and preserved liver function is poor. Primary LT should be offered to these patients.
authors: Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75012 Paris, France.
authors: Mircea
authors: M
authors: Chirica
authors: Hadrien
authors: H
authors: Tranchart
authors: Viriane
authors: V
authors: Tan
authors: Matthieu
authors: M
authors: Faron
authors: Pierre
authors: P
authors: Balladur
authors: François
authors: F
authors: Paye
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D016174:Hepacivirus; D006498:Hepatectomy; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D052096:Warm Ischemia / Q000009:adverse effects*