title: Evaluation of prognostic factors on recurrence after curative resections for hepatocellular carcinoma.
abstract: OBJECTIVE
  To select appropriate patients before surgical resection for hepatocellular carcinoma (HCC), especially those with advanced tumors.
  
  
  METHODS
  From January 2000 to December 2012, we retrospectively analyzed the medical records of 298 patients who had undergone surgical resections for HCC with curative intent at our hospital. We evaluated preoperative prognostic factors associated with histologic grade of tumor, recurrence and survival, especially the findings of pre-operative imaging studies such as positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI). And then, we established a scoring system to predict recurrence and survival after surgery dividing the patients into two groups based on a tumor size of 5 cm.
  
  
  RESULTS
  Of the 298 patients, 129 (43.3%) developed recurrence during the follow-up period. The 5 year disease free survival and overall survival were 47.0% and 58.7% respectively. In multivariate analysis, a serum alpha-fetoprotein (AFP) level of > 100 ng/mL and a standardized uptake value (SUV) of PET-CT of > 3.5 were predictive factors for histologic grade of tumor, recurrence, and survival. Tumor size of > 5 cm and a relative enhancement ratio (RER) calculated from preoperative MRI were also significantly associated with prognosis in univariate analysis. We established a scoring system to predict prognosis using AFP, SUV, and RER. In those with tumors of > 5 cm, it showed predicted both recurrence (P = 0.005) and survival (P = 0.001).
  
  
  CONCLUSIONS
  The AFP, tumor size, SUV and RER are useful for prognosis preoperatively. An accurate prediction of prognosis is possible using our scoring system in large size tumors.
authors.affiliation: Jae Hyun Han, Dong Goo Kim, Gun Hyung Na, Eun Young Kim, Soo Ho Lee, Tae Ho Hong, Young Kyoung You, Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul 137-701, South Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Han
authors.affiliation: Jae Hyun Han, Dong Goo Kim, Gun Hyung Na, Eun Young Kim, Soo Ho Lee, Tae Ho Hong, Young Kyoung You, Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul 137-701, South Korea.
authors.forename: Dong Goo
authors.initials: DG
authors.lastname: Kim
authors.affiliation: Jae Hyun Han, Dong Goo Kim, Gun Hyung Na, Eun Young Kim, Soo Ho Lee, Tae Ho Hong, Young Kyoung You, Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul 137-701, South Korea.
authors.forename: Gun Hyung
authors.initials: GH
authors.lastname: Na
authors.affiliation: Jae Hyun Han, Dong Goo Kim, Gun Hyung Na, Eun Young Kim, Soo Ho Lee, Tae Ho Hong, Young Kyoung You, Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul 137-701, South Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.affiliation: Jae Hyun Han, Dong Goo Kim, Gun Hyung Na, Eun Young Kim, Soo Ho Lee, Tae Ho Hong, Young Kyoung You, Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul 137-701, South Korea.
authors.forename: Soo Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Jae Hyun Han, Dong Goo Kim, Gun Hyung Na, Eun Young Kim, Soo Ho Lee, Tae Ho Hong, Young Kyoung You, Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul 137-701, South Korea.
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Hong
authors.affiliation: Jae Hyun Han, Dong Goo Kim, Gun Hyung Na, Eun Young Kim, Soo Ho Lee, Tae Ho Hong, Young Kyoung You, Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul 137-701, South Korea.
authors.forename: Young Kyoung
authors.initials: YK
authors.lastname: You
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins
keywords: Carcinoma; Hepatectomy; Hepatocellular; Prognostic factor; Recurrence; Survival