title: Total tumor volume predicts survival following liver resection in patients with hepatocellular carcinoma.
abstract: Assessing the prognosis of patients with hepatocellular carcinoma (HCC) by the number and size of tumors is sometimes difficult. The main purpose of the study was to evaluate the prognostic value of total tumor volume (TTV), which combines the two factors, in patients with HCC who underwent liver resection. We retrospectively reviewed 521 HCC patients from January 2001 to December 2008 in our center. Patients were categorized using the tertiles of TTV. The prognostic value of TTV was assessed. With a median follow-up of 116 months, the 1-, 3-, and 5-year overall survival (OS) rates of the patients were 93.1 , 69.9, and 46.3 %, respectively. OS was significantly differed by TTV tertile groups, and higher TTV was associated with shorter OS (P < 0.001). Multivariate analysis revealed that TTV was an independent prognostic factor for OS. Larger TTV was significantly associated with higher alpha-fetoprotein level, presence of macrovascular invasion, multiple tumor lesions, larger tumor size, and advanced tumor stages (all P < 0.05). Within the first and second tertiles of TTV (TTV ≤ 73.5 cm(3)), no significant differences in OS were detected in patients within and beyond Milan criteria (P = 0.183). TTV-based Cancer of the Liver Italian Program (CLIP) score gained the lowest Akaike information criterion value, the highest χ (2) value of likelihood ratio test, and the highest C-index among the tested staging systems. Our results suggested that TTV is a good indicator of tumor burden in patients with HCC. Further studies are warranted to validate the prognostic value of TTV.
authors.affiliation: Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China.
authors.forename: Mu-Xing
authors.initials: MX
authors.lastname: Li
authors.affiliation: Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China.
authors.forename: Xin-Yu
authors.initials: XY
authors.lastname: Bi
authors.affiliation: Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China.
authors.forename: Zhi-Yu
authors.initials: ZY
authors.lastname: Li
authors.affiliation: Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of Interventional Therapies, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China.
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Zhou
authors.affiliation: Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Zhao
authors.affiliation: Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China.
authors.forename: Ye-Fan
authors.initials: YF
authors.lastname: Zhang
authors.affiliation: Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China.
authors.forename: Wen-Qiang
authors.initials: WQ
authors.lastname: Wei
authors.affiliation: Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China.
authors.forename: Dong-Bin
authors.initials: DB
authors.lastname: Zhao
authors.affiliation: Department of Abdominal Surgical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), No. 17, Panjiayuan Nanli, Beijing, 100021, People's Republic of China. caijianqiang@cicams.ac.cn.
authors.forename: Jian-Qiang
authors.initials: JQ
authors.lastname: Cai
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden
keywords: Hepatocellular carcinoma; Prognosis; Total tumor volume; Tumor burden