title: Predictors of recurrence in hepatitis C virus related hepatocellular carcinoma after hepatic resection: a retrospective cohort study.
abstract: OBJECTIVE
  Egypt is one of the hot spots in the international map of Hepatocellular carcinoma (HCC), which is where hepatitis C virus (HCV) infection is the major risk factor in development of HCC (80%). Due to low organ donation rates and lack of deceased liver transplantation, hepatic resection is the main line of treatment for HCC patients with sufficient liver reserve. We introduce our experience with patients who had HCV related HCC who underwent hepatic re-section to determine various predictors of tumour recurrence in this group. This is the first study to come from a country where chronic HCV hepatitis is endemic.
  
  
  METHODS
  This is a retrospective cohort study of 208 cases of HCC in hepatitis C virus positive patients with cirrhotic livers who underwent first-time liver resection, in Gastroenterology Surgical Centre, Mansoura University, Egypt during the period from January 2002 to December 2011. Shapiro-Wilk test was used to assess normality of data. Predictors of HCC recurrence were assessed by bivariate correlation tests, univariate analysis using the chi-square and t-test and binary logistic regression analysis. A P value <0.05 was considered statistically significant.
  
  
  RESULTS
  Tumour recurrence occurred in 88 patients (42.3%). Most of the recurrences occurred within the first year 55 patients (62.5%). The most common site for recurrence was the liver (n=68, 77.3%). Based on the univariate analysis; significant variables predicting tumor recurrence were alpha feto-protein (AFP), blood transfusion, multi-focality, cut margin, microvascular invasion, lack of capsule, tumour grade and stage. Based on multivariate analysis, the main variables predicting tumor recurrence were blood transfusion, cut margin, tumour capsule and microvascular invasion.
  
  
  CONCLUSIONS
  Although the predictors of recurrence are the same for both HBV and HCV related HCC, the rate and aggressiveness of recurrence are higher in HCV related HCC.
authors.affiliation: Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Dakahlia, Egypt.
authors.forename: Mohamed Abdel
authors.initials: MA
authors.lastname: Wahab
authors.affiliation: Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Dakahlia, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shehta
authors.affiliation: Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Dakahlia, Egypt.
authors.forename: Hosam
authors.initials: H
authors.lastname: Hamed
authors.affiliation: Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Dakahlia, Egypt.
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.affiliation: Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Dakahlia, Egypt.
authors.forename: Tarek
authors.initials: T
authors.lastname: Salah
keywords: HCV related HCCs; liver resection; recurrent HCC