title: Analysis of the risk factors of untransplantable recurrence after primary curative resection for patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  To determine the prognostic factors that predict recurrence of hepatocellular carcinoma (HCC) exceeding the University of California at San Francisco (UCSF) criteria after primary resection.
  
  
  METHODS
  HCC patients who underwent curative liver resections between 2001 and 2007 and who were within the UCSF criteria (n = 716) were examined. Independent prognostic factors were examined by the Cox proportional hazard model.
  
  
  RESULTS
  A total of 285 patients (39.8 %) developed recurrences. Of the patients who developed recurrences, 180 had HCC still within the UCSF criteria (63.2 %), and 105 developed HCC beyond this criteria (36.8 %). Among the population with primary transplantable HCC, patients with larger primary tumor sizes, serum α-fetoprotein (AFP) levels over 400 ng/mL, satellite nodules, vascular invasion, or undifferentiated HCC had a risk of untransplantable recurrence, as shown by univariate analysis. In multivariate analysis, undifferentiated HCC and vascular invasion were identified as the significant predictors with adjusted hazard ratios of 9.25 [95 % confidence interval (CI) 2.13-40.21] and 2.19 (95 % CI 1.34-3.58), respectively. When only preoperative factors were considered in multivariate analysis, primary tumor size and serum AFP levels over 400 ng/mL were identified as significant predictors with adjusted hazard ratios of 1.24 (95 % CI 1.07-1.45) and 1.72 (95 % CI 1.05-2.82), respectively.
  
  
  CONCLUSIONS
  For primary HCC patients within the UCSF criteria, larger tumor sizes and AFP levels over 400 ng/mL were associated with postresection recurrence of HCC exceeding the UCSF criteria. Because these are clearly markers for aggressive tumor biology, whether early primary transplant will alter the aggressive tumor behaviors warrant further investigation.
authors.affiliation: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Cheng-Maw
authors.initials: CM
authors.lastname: Ho
authors.forename: Chao-Ying
authors.initials: CY
authors.lastname: Wu
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Lee
authors.forename: Hong-Shiee
authors.initials: HS
authors.lastname: Lai
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Ho
authors.forename: Yao-Ming
authors.initials: YM
authors.lastname: Wu
authors.forename: Rey-Heng
authors.initials: RH
authors.lastname: Hu
mesh_terms: D000368:Aged; D001808:Blood Vessels / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018579:Patient Selection; D012307:Risk Factors; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins