title: Patterns of cancer recurrence in localized resected hepatocellular carcinoma.
abstract: BACKGROUND
  Tumor resection in non-metastatic hepatocellular carcinoma (HCC) patients with adequate liver reserve offers a potential cure, but has a high 5-year recurrence rate. We analyzed the patterns of cancer relapse after partial hepatectomy to guide post-operative management.
  
  
  METHODS
  A total of 144 HCC patients (1996-2011) after partial hepatectomy were reviewed. Statistical correlations were determined using univariate and partition analyses.
  
  
  RESULTS
  A median follow-up of 20 months showed recurrence in 71 (49%) patients, and the median time to recurrence was 11.9 months. Vascular invasion (P<0.01) and number of lesions (P<0.01) predicted for recurrence. Histologic grade was not correlated with recurrence. Twenty-two (31%) patients developed both surgical margin (SM) and concurrent intrahepatic recurrences, and 28 (40%) had non-SM intrahepatic recurrences with no other signs of recurrence. On partition analysis, the risk of marginal recurrence in patients with SM <1 mm and SM ≥1 mm was 35% and 13.5% respectively. Approximately 57% of patients with intrahepatic recurrence had recurrence ≤2.5 cm from SM.
  
  
  CONCLUSIONS
  Intrahepatic recurrence after partial hepatectomy is common and is significantly associated with vascular invasion and tumor stage. About 57% of patients with intrahepatic relapse had a recurrence close (≤2.5 cm) to the SM. Additionally, patients with SM <1 mm have a higher recurrence rate and may benefit from adjuvant local therapy.
authors.affiliation: Department of Radiation Oncology, 9500 Euclid Ave, T28, Cleveland Clinic, Cleveland OH 44195, USA. aryavarta.kumar@gmail.com.
authors.forename: Aryavarta Ms
authors.initials: AM
authors.lastname: Kumar
authors.forename: Elisha T
authors.initials: ET
authors.lastname: Fredman
authors.forename: Christopher
authors.initials: C
authors.lastname: Coppa
authors.forename: Galal
authors.initials: G
authors.lastname: El-Gazzaz
authors.forename: Federico N
authors.initials: FN
authors.lastname: Aucejo
authors.forename: May
authors.initials: M
authors.lastname: Abdel-Wahab
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome