title: Postoperative recurrence pattern and prognosis of patients with hepatocellular carcinoma, with particular reference to the hepatitis viral infection status.
abstract: OBJECTIVE
  Various modalities have been employed effectively according to the tumour recurrence status in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. Therefore, their overall prognosis depends largely on the pattern of recurrence/treatment. We investigated the patterns of recurrence and prognosis in HCC patients, especially in relation to the hepatitis virus infection status.
  
  
  METHODS
  The study population comprised 244 patients with HCC undergoing hepatectomy. Curative treatments, including repeated hepatectomies, were performed for recurrences, whenever possible. Detailed information on recurrences was collected until the recurrences exceeded Milan criteria.
  
  
  RESULTS
  The 5-year disease-free survival, survival within the Milan criteria and overall survival were 38.4%, 56.3% and 74.5% respectively. In the comparison between patients with hepatitis C and B virus-related HCC (HC-HCC: n = 122; and HB-HCC: n = 45 respectively), the former showed lower disease-free (30.2% vs. 40.7% at 5 years, P = 0.061) and overall (65.7% vs. 89.7% at 5 years, P = 0.011) survivals; they also showed a higher incidence of multinodular (≥4) intrahepatic recurrences (19.4% vs. 5.3% at 3 years, P = 0.010). However, the incidences of recurrences exceeding the Milan criteria because of other components were comparable. Patients with HC-HCC showed a higher incidence of intrahepatic recurrences characterized by multiple lesions and the difference became increasingly more pronounced with time.
  
  
  CONCLUSIONS
  Patients with HC-HCC were associated with a higher carcinogenesis in the background liver than those with HB-HCC, and this difference was aggravated with time after hepatic resection.
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Naito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Akira
authors.initials: A
authors.lastname: Tukada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Matsuyama
authors.forename: Jiro
authors.initials: J
authors.lastname: Yoshimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugo
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ishizaki
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawasaki
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000821:virology*; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000821:virology*; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Milan criteria; hepatitis B; hepatitis C; hepatocellular carcinoma; prognosis