title: How to improve the outcome in patients with AJCC stage I hepatocellular carcinoma.
abstract: OBJECTIVE
  Survival of patients with stage I hepatocellular carcinoma (HCC) is higher than in patients with more advanced disease, however many of them will ultimately die of tumor recurrence and liver failure. Our objective focuses on identifying the pathological and clinical factors that could affect disease-free (DFS) and overall survival (OS). In addition we reviewed the treatment offered for recurrence and its impact on OS.
  
  
  METHODS
  Between January 1992 and December 2002, a total of 473 patients who underwent hepatectomy for HCC at the Kaohsiung Chang Gung Memorial Hospital were enrolled in this study. Relevant clinicopathological and perioperative variables were subjected to univariate and multivariate analysis.
  
  
  RESULTS
  A total of 224 patients with a mean follow-up period of 4.6 years were analyzed. The 1-, 3-, 5-, and 10-year DFS rates were 82.5%, 57.6%, 46.9% and 32.0% respectively. The 1-, 3-, 5-, and 10-year OS rates were 91.5%, 83.0%, 70.1% and 56.3% respectively. The multivariate analysis identified age >50 years, Indocyanine Green (ICG) clearance test and cirrhosis as independent factors that negatively impact DFS and age ≥ 50 years, resection type, presence of complications and tumor recurrence as factors affecting OS. In patients with recurrence (n=130), the factors that negatively impact OS were blood transfusion, age ≥ 50, blood loss and presence of surgical complications.
  
  
  CONCLUSIONS
  Meticulous surgical technique is the key to improving the outcome of patients with stage I HCC. The presence of complications was the only modifiable clinicopathological factor that affected the OS in our study.
authors.affiliation: Division of General Surgery, Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Anthony Q
authors.initials: AQ
authors.lastname: Yap
authors.affiliation: Division of General Surgery, Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Millan
authors.affiliation: Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Jing-Houng
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Division of General Surgery, Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan, R.O.C. ufel4996@ms26.hinet.net.
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Sen-Nan
authors.initials: SN
authors.lastname: Lu
authors.affiliation: Division of General Surgery, Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Shih-Ho
authors.initials: SH
authors.lastname: Wang
authors.affiliation: Division of General Surgery, Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Division of General Surgery, Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Yueh-Wei
authors.initials: YW
authors.lastname: Liu
authors.affiliation: Division of General Surgery, Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Chee-Chien
authors.initials: CC
authors.lastname: Yong
authors.affiliation: Division of General Surgery, Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Li
authors.affiliation: Division of General Surgery, Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Ting-Lung
authors.initials: TL
authors.lastname: Lin
authors.affiliation: Division of General Surgery, Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taiwan, R.O.C.
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate
keywords: Hepatocellular carcinoma; clinical; disease-free survival; overall survival; pathological; surgical