title: Outcomes following liver resection and clinical pathologic characteristics of hepatocellular carcinoma occurring in patients with chronic hepatitis B and minimally fibrotic liver.
abstract: OBJECTIVE
  The intent of this analysis is to assess clinico-pathologic and prognostic characteristics of HCC in patients with minimal liver fibrosis (Ishak stage 1-2) after primary surgical liver resection as compared to patients with moderate to severe fibrosis (Ishak stage 3-6) in order to improve screening and treatment of HCC.
  
  
  METHODS
  Data were obtained from 200 patients with HBV-related HCC who underwent primary surgical liver resection at a single North American medical institution between 1988 and 2012. A dedicated liver pathologist performed fibrosis staging for each resection specimen using the modified Ishak method. Univariate and multivariate analyses of clinico-pathologic variables were performed to determine those associated with prognosis.
  
  
  RESULTS
  Twenty-two percent of patients had minimal fibrosis defined as Ishak stage 1 or 2. Kaplan-Meier analysis of 5-year survival showed a non-significant trend toward better outcome among Ishak 1-2 patients compared to Ishak 3-6 (p = 0.09). Ishak 1-2 was associated with lower hazard of death compared to Ishak 3-6 (adjusted HR = 0.38, 95% CI = 0.15-0.99). Ishak 1-2 retained statistical significance after multivariate analysis for overall survival (p = 0.05), but not recurrence-free survival.
  
  
  CONCLUSIONS
  A significant proportion of HBV-HCC cases arise in the minimally fibrotic liver. Patients with Ishak 1-2 fibrosis have better overall survival compared to those with Ishak 3-6, indicating that minimally fibrotic patients should be treated as a separate cohort. There is a need to better understand the mechanisms underlying hepatocarcinogenesis and to formulate unique diagnostic and therapeutic algorithms for minimally fibrotic HCC patients.
authors.affiliation: Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: H S
authors.initials: HS
authors.lastname: Kadri
authors.forename: S
authors.initials: S
authors.lastname: Blank
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.forename: K W
authors.initials: KW
authors.lastname: Kim
authors.forename: M I
authors.initials: MI
authors.lastname: Fiel
authors.forename: W
authors.initials: W
authors.lastname: Luan
authors.forename: S P
authors.initials: SP
authors.lastname: Hiotis
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery* / Q000821:virology; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged
keywords: Cirrhosis; HBV; HCC; Ishak fibrosis stage; Liver resection