Intrahepatic metastasis is more risky than multiple occurrence in hepatocellular carcinoma patients after curative liver resection.
OBJECTIVE
The characteristics of multiple nudules in hepatocellular carcinomas (HCCs) after curative liver resection remain obscure. We compare the clinicopathologic characteristics and prognoses between patients with hepatic lesions with multicentric occurrence (MO) and intrahepatic metastasis (IM) at the time of surgical resection.


METHODS
The histopathologic features of multiple tumors from 198 patients of HCC were analyzed and divided into MO group (n = 51, 25.8%) for multicentric HCCs and an IM group (n = 147, 74.2%) in cases with intrahepatic metastases. Overall survival rate, disease-free survival and clinicopathologic differences were compared between the two groups.


RESULTS
Microvascular invasion and increased tumor size were the most important factors discriminating the IM group from the MO group (P < 0.001 and P = 0.027, respectively). Kaplan-Meier and log rank tests revealed that disease-free survival and overall survival rates in the MO group were significantly higher than those for the IM group (P < 0.001 and P < 0.001, respectively). A multivariate analysis of Cox's proportional hazards model showed that increased alpha-fetoprotein (AFP) and protein induced by vitamin K antagonist-II (PIVKA-II) levels, portal vein invasion and intrahepatic metastases were the most important prognostic factors.


CONCLUSIONS
Among HCCs, the prognosis of patients with MO is significantly better than that of patients with IM.
Jong Man
JM
Kim
Choon Hyuck David
CH
Kwon
Jae-Won
JW
Joh
Jae Berm
JB
Park
Joon Hyeok
JH
Lee
Sung Joo
SJ
Kim
Seung Woon
SW
Paik
Cheol Keun
CK
Park
D000328:Adult; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; 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*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011169:Portal Vein / Q000473:pathology; D016016:Proportional Hazards Models; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000032:analysis
C097353:AFP protein, human; D015415:Biomarkers; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin