title: The meaning of gross tumor type in the aspects of cytokeratin 19 expression and resection margin in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  There is no consensus on the safe resection margin in patients with hepatocellular carcinoma. Surgeons decide the extent of resection according to residual liver function and tumor location. We investigated the influence of resection margin on early recurrence with respect to gross tumor type and expression of cytokeratin 19 (CK19).
  
  
  METHODS
  We divided the patients into two groups based on the classification of The Korean Liver Cancer Study group as follows: group 1 included expanding and vaguely nodular types whereas group 2 included nodular with perinodular extension, multinodular confluent, and infiltrative types. We classified the resection margin as narrow (0.1-0.9 cm) or wide (greater than 1 cm). We compared clinicopathological features and CK19 positivity between the groups.
  
  
  RESULTS
  Group 2 had a higher prevalence of gross portal vein invasion, microscopic portal vein invasion, microvessel invasion, satellite nodules, intrahepatic metastasis, multicentric occurrence, and positivity for CK19. Group 1 showed no difference in recurrence according to the resection margin; however, group 2 showed a higher recurrence rate in patients with a narrow resection margin compared with those with a wide resection margin (P = 0.047). Patients in group 2 with CK19 positivity showed a higher prevalence of microvessel invasion than those without CK19 (P = 0.026).
  
  
  CONCLUSIONS
  Although our study has the limitation of a small number of cases, the data suggest that patients with hepatocellular carcinoma of expanding and vaguely nodular gross types may safely undergo surgical resection with a narrow resection margin and a low risk of early recurrence.
authors.affiliation: Department of Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: Sung Chan
authors.initials: SC
authors.lastname: Gong
authors.affiliation: Department of Pathology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: Mee-Yon
authors.initials: MY
authors.lastname: Cho
authors.affiliation: Graduate School of Yonsei University, Seoul, Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: Moon Young
authors.initials: MY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000235:genetics* / Q000473:pathology / Q000601:surgery*; D005260:Female; D015870:Gene Expression; D006498:Hepatectomy; D006801:Humans; D053539:Keratin-19 / Q000235:genetics*; D008099:Liver / Q000098:blood supply; D008113:Liver Neoplasms / Q000145:classification / Q000235:genetics* / Q000473:pathology / Q000601:surgery*; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D011169:Portal Vein / Q000473:pathology; D015995:Prevalence; D012306:Risk; D012449:Safety
chemical_list: D053539:Keratin-19
keywords: cytokeratin 19; gross type; hepatocellular carcinoma; resection margin