title: Prediction of aggressiveness in early-stage hepatocellular carcinoma for selection of surgical resection.
abstract: OBJECTIVE
  In early-stage hepatocellular carcinoma (eHCC), radiofrequency ablation (RFA) has comparable outcomes to surgical resection (SR); however, micrometastases may be present, resulting in tumor recurrence after local ablation. Therefore, we investigated predictors of aggressiveness in eHCC to select patients at high risk of recurrence after RFA who would benefit from SR.
  
  
  METHODS
  First, we analyzed 128 patients with newly diagnosed eHCC (single tumor with a diameter <3 cm) who underwent SR between January 2006 and December 2011. Risk factors for micrometastasis (representative of tumor aggressiveness) such as microvascular invasion or poor histologic grade were investigated. We then analyzed 201 eHCC patients who underwent RFA between July 2007 and December 2011. Identified risk factors were validated to determine their influence on tumor recurrence.
  
  
  RESULTS
  The only significant risk factor for tumor aggressiveness in the SR group was the product of serum levels of α-fetoprotein (AFP) and prothrombin induced by vitamin K absence-II (PIVKA-II) (A∗P ≥1600; hazard ratio [HR] 4.764; 95% confidence interval [CI], 1.867-12.161; p=0.001). This product also showed statistical significance for predicting recurrence in the RFA group (HR 2.296; 95% CI, 1.237-4.262; p=0.008). Patients with RFA and A∗P ≥1600 had significant early tumor recurrence (p=0.008) and poor late survival outcomes (p=0.001) compared with other patients.
  
  
  CONCLUSIONS
  The product of AFP and PIVKA-II levels is a useful predictor of aggressiveness in eHCC, which predicts tumor recurrence after RFA. Therefore, it should be considered when selecting SR as first-line treatment.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
authors.forename: Suk-Won
authors.initials: SW
authors.lastname: Suh
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea. Electronic address: Kwleegs@gmail.com.
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
authors.forename: Jeong-Moo
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
authors.forename: Tae
authors.initials: T
authors.lastname: You
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
authors.forename: YoungRok
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul 156-707, Republic of Korea.
authors.forename: Hyeyoung
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul 156-707, Republic of Korea.
authors.forename: Hae Won
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
authors.forename: Jeong-Min
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
keywords: Aggressiveness; Early-stage hepatocellular carcinoma; Prediction; Radio frequency ablation; Surgical resection