title: Impact of histologically confirmed lymph node metastases on patient survival after surgical resection for hepatocellular carcinoma: report of a Japanese nationwide survey.
abstract: OBJECTIVE
  To clarify the clinical significance of resection of lymph node metastases in patients' hepatocellular carcinoma (HCC).
  
  
  BACKGROUND
  Although the presence of lymph node metastasis form HCC has been considered as a systemic disease, prognosis after resection of them remains unknown.
  
  
  METHODS
  From the database of a Japanese nationwide survey, 14,872 patients of HCC treated by surgical resection between 2000 and 2005 were enrolled. We modified the current Japanese staging system for HCC, by further dividing stage IVA into stage IVAnon-n1 and stage n1, according to the absence or presence of pathologically proven lymph node metastasis. Thus, the patients classified into 6 disease stages, that is, I (n=1494), II (n=8056), III (n=4243), IVAnon-n1 (n=701), n1 (n=112), and IVB (n=266), and their long-term outcomes were compared.
  
  
  RESULTS
  The median follow-up period was 20.6 months. The 3-year overall survival rates of the patients with stage IVAnon-n1, stage n1, and stage IVB were 51.6%, 38.9% and 27.2%, respectively. A multivariate analysis showed that stage IVAnon-n1 would have a similar impact on the survival as stage n1 (hazard ratio: 0.88, 95% confidence interval: 0.59-1.33, P=0.555), and that stage n1 still represented one class less advanced than stage IVB (hazard ratio: 0.52, 95% confidence interval: 0.34-0.80, P=0.003).
  
  
  CONCLUSIONS
  The prognosis of patients with histologically node-positive HCC was similar to that of patients with locally advanced HCC (stage IVA), which supports the validity of the current Japanese staging system and also partially validates the system proposed by the UICC/AJCC.
authors.affiliation: *Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo †Japanese Red Cross Medical Center ‡Department of Gastroenterology, Musashino Red Cross Hospital §Department of Gastroenterology, Juntendo University Shizuoka Hospital ¶Department of Gastroenterology and Hepatology, Kinki University School of Medicine ‖Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine **Department of Pathology, Keio University School of Medicine ††Department of Clinical Laboratory Medicine, Kurume University Hospital ‡‡Department of Radiology, Kanazawa University Graduate School of Medical Science; and §§Department of Biostatics, School of Public Health University of Tokyo.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Namiki
authors.initials: N
authors.lastname: Izumi
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ichida
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
authors.forename: Michiie
authors.initials: M
authors.lastname: Sakamoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Nakashima
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Matsuyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D019538:Health Care Surveys; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis