title: The effect of alkaline phosphatase and intrahepatic metastases in large hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatectomy is the standard treatment for HCC. However, large HCC poses a difficult challenge because of the technical complexity of surgical resection and the fear of postoperative hepatic decompensation. We analyzed the outcome and prognostic factors in patients with large hepatocellular carcinoma (HCC ≥10 cm) after surgery.
  
  
  METHODS
  We retrospectively investigated the medical records of 91 patients who had undergone hepatectomy between January 2006 and June 2010. A survival analysis was performed utilizing the Kaplan-Meier method and prognostic factors were evaluated using Cox regression analysis.
  
  
  RESULTS
  Of the 91 patients evaluated, most tumors were associated with hepatitis B virus (HBV). The median tumor size was 12.3 cm (range, 10 to 21 cm), with microvascular invasion present in most patients. The postoperative mortality rate was 2.2%. The median disease-free survival and overall survival were six months and 41 months. The one-year, two-year, and three-year disease-free survival rates were 33.5%, 29.3%, and 18.8%, respectively. The one-year, two-year, and three-year overall survival rates were 73.9%, 63.7%, and 54.8%, respectively. Of the 89 surviving patients, 69 patients (77.5%) developed HCC recurrence during the mean follow-up period of 23.4 ± 15.9 months. On multivariate analysis, the statistically significant factors that predicted HCC recurrence were ALP ≥ 80 IU/mL (P = 0.009) and intrahepatic metastases (P = 0.013).
  
  
  CONCLUSIONS
  Our study suggests that preoperative ALP levels (≥ 80 IU/L) and intrahepatic metastases could be utilized to monitor and predict recurrence in HCC patients.
authors: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50 Ilwon-Dong Gangnam-Gu, 135-710, Seoul, Korea.
authors: Jong Man
authors: JM
authors: Kim
authors: Choon Hyuck David
authors: CH
authors: Kwon
authors: Jae-Won
authors: JW
authors: Joh
authors: Jae Berm
authors: JB
authors: Park
authors: Justin Sangwook
authors: JS
authors: Ko
authors: Joon Hyeok
authors: JH
authors: Lee
authors: Sung Joo
authors: SJ
authors: Kim
authors: Cheol-Keun
authors: CK
authors: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality* / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000469:Alkaline Phosphatase