title: Early intrahepatic recurrence of hepatocellular carcinoma after hepatectomy treated with re-hepatectomy, ablation or chemoembolization: a prospective cohort study.
abstract: OBJECTIVE
  To observe the outcomes of various treatments for patients with early intrahepatic recurrent hepatocellular carcinoma (HCC) after partial hepatectomy.
  
  
  METHODS
  A total of 629 patients with intrahepatic recurrent HCC within Milan criteria following hepatectomy were prospectively collected between November 2004 and May 2010. Overall survival (OS) and recurrence to death survival (RTDS) were analyzed by the Kaplan-Meier method and log-rank test. Cox regression analysis was used for multivariate analyses.
  
  
  RESULTS
  The 5-year OS and RTDS rates were 64.5%, 43.0%; 37.0%, 26.7%; 27.7% and 8.3% for patients who received re-hepatectomy (n = 128), percutaneous radiofrequency ablation (PRFA, n = 162) and transarterial chemoembolization (TACE, n = 339) (re-hepatectomy vs. TACE, P < 0.001, <0.001; vs. PRFA, P = 0.005, 0.008; PRFA vs. TACE, P < 0.001, <0.001). The independent predictors of OS and RTDS were tumor number (hazard ratio: 1.54, 95% confidence interval: 1.18-2.00; 1.57, 1.21-2.04), alpha fetoprotein >20 ng/mL (1.64, 1.24-2.17; 1.66, 1.26-2.20), presence of varices (1.69, 1.28-2.22; 1.61, 1.23-2.10) and Edmondson-Steiner grade III-IV (1.66, 1.17-2.35; 1.70, 1.20-2.40) at the initial stage; and tumor number (1.34, 1.04-1.73; 1.32, 1.03-1.70), time to recurrence (TTR) (3.46, 2.58-4.65; 1.59, 1.19-2.14) and treatment for recurrence (TACE: 3.18, 2.16-4.66; 2.95, 2.02-4.31; PRFA: 1.49, 0.97-2.29; 1.44, 0.94-2.19).
  
  
  CONCLUSIONS
  For early intrahepatic recurrent HCC, re-hepatectomy achieved best outcome. It produced similar result as PRFA for patients with more invasive primary tumors and underlying cirrhosis/varices. TACE had worst prognosis which was only suitable for multifocal recurrence and TTR ≤1 year.
authors.affiliation: Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: K
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of Interventional Radiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: G
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Yan
authors.affiliation: Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of Clinical Database, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. Electronic address: xia.yong@126.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Xia
authors.affiliation: Department of Clinical Database, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: X
authors.initials: X
authors.lastname: Wan
authors.affiliation: Department of General Surgery, the Second Hospital of Wuxi, Wuxi, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Ji
authors.affiliation: Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
authors.forename: W Y
authors.initials: WY
authors.lastname: Lau
authors.affiliation: Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of Clinical Database, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: M
authors.initials: M
authors.lastname: Wu
authors.affiliation: Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Department of Clinical Database, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. Electronic address: shenfengehbh@sina.com.
authors.forename: F
authors.initials: F
authors.lastname: Shen
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D000078702:Radiofrequency Therapy; D012086:Reoperation; D019233:Retreatment; D015996:Survival Rate; D013997:Time Factors; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D000509:alpha-Fetoproteins
keywords: Ablation; Chemoembolization; Hepatectomy; Hepatocellular carcinoma; Intrahepatic recurrence