title: Tumor existence and tumor size as prognostic factors in hepatitis B virus-related cirrhosis patients who underwent liver transplantation.
abstract: BACKGROUND
  Hepatitis B virus (HBV)-related chronic liver disease is one of the most common indications for liver transplantation (LT). Patient data in our unit were collected to evaluate the impact of liver tumor on outcomes in patients with HBV-related cirrhosis who underwent LT.
  
  
  METHODS
  HBV transplantation patients in our hospital from August 2002 to March 2012 were analyzed and compared according to LT indications: decompensated cirrhosis (DEC) or hepatocellular carcinoma (HCC). For HCC patients, receiver operating characteristic (ROC) curve analysis was used to determine the cutoff tumor size for prognosis, namely the maximum tumor diameter. According to the cutoff size, patients were divided into 2 groups: large-size HCC and small-size HCC. The correlations among other clinicopathologic factors were also investigated. Potential prognostic factors were evaluated with the use of Cox proportional hazards model analysis.
  
  
  RESULTS
  The 1-, 3-, and 5-year overall survival rates of the 111 HBV-related patients were 76.2%, 43.2%, and 32.9%, respectively. Patients with HCC had significantly poorer overall survival than those with only DEC (P < .05). The mean tumor size was 5.97 cm, and ROC analysis indicated that the cutoff tumor size for prognosis was 4.25 cm, with sensitivity and specificity of 62.8% and 81.0%, respectively (area under the ROC curve, 0.760; 95% CI, 0.644-0.877; P < .001). According to this cutoff point, 31 patients had large tumor size (≥ 4.25 cm) and 33 had small tumor size (<4.25 cm). Patients with small tumor size had significantly better overall survival than those with large tumor size (P < .05). Univariate analysis showed that only the tumor size (risk ratio, 1.14; P < .001) was significantly associated with the overall survival.
  
  
  CONCLUSIONS
  Tumor existence and tumor size are prognostic factors in HBV-related cirrhosis. With the use of a tumor size cutoff value of 4.25 cm, patients with large-size tumors have significantly poorer overall survival than those with small-size tumors.
authors.affiliation: Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China.
authors.forename: X
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China.
authors.forename: K
authors.initials: K
authors.lastname: Qu
authors.affiliation: Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wan
authors.affiliation: Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China.
authors.forename: S
authors.initials: S
authors.lastname: Song
authors.affiliation: Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China.
authors.forename: Z
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China.
authors.forename: Z
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, People's Republic of China. Electronic address: liuchangdoctor@163.com.
authors.forename: C
authors.initials: C
authors.lastname: Liu
mesh_terms: D000328:Adult; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate