title: Prognostic factors for survival after hepatic resection of early hepatocellular carcinoma in HBV-related cirrhotic patients.
abstract: OBJECTIVE
  The study aimed to identify clinico-pathologic factors that predict survival in early hepatocellular carcinoma (HCC) patients with hepatitis B virus (HBV)-related cirrhosis undergoing liver resection.
  
  
  METHODS
  A population-based cohort was investigated to identify cirrhotic patients with confirmed early HCC (tumor size≤5cm and absence of nodal involvement, metastases, or major vascular invasion) after hepatic resection at the Eastern Hepatobiliary Surgery Hospital (Shanghai, China) from April 2005 and November 2010 using the Surveillance, Epidemiology, and End Results (SEER) database. These patients were studied retrospectively in terms of their clinical characteristics and prognostic factors. Predictors for survival were evaluated using Kaplan-Meier methods and Cox proportional hazards models. Besides, a simple prognostic scoring system was proposed to stratify these patients.
  
  
  RESULTS
  Of 537 (2.6% of all HCC patients in this period) cirrhotic patients with early HCC identified who had underwent liver resection, 87% were male. Median tumor size was 2.9cm, and 67% of patients had tumors>2cm. Following hepatic resection, overall median and 5-year survival were 75 months and 58%, respectively. Tumor size>2cm (hazard ratio [HR]=1.56), multifocality (HR=1.34), non-anatomic resection (HR=1.44) and vascular invasion (HR=2.03) were associated with worse prognosis (P<0.05). Moreover, these patients could be further stratified into 4 distinct prognostic groups based on the prognostic scoring system developed.
  
  
  CONCLUSIONS
  Tumor size>2cm, multifocality, non-anatomic resection and vascular invasion may be used to stratify HBV-related cirrhotic patients with early HCC after resection. Besides, these data also indicate that pathologic staging is important even in small HCC.
authors.affiliation: Department of Hepatobiliary Surgery, Jingmen First People's Hospital, 67, Xiangshan Avenue, 448000 Jingmen, Hubei Province, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: Department of Hepatobiliary Surgery, 455 Hospital of People's Liberation Army, 200052 Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yuan
authors.affiliation: Department of Medical Oncology, Capital Medical University Cancer Center, Beijing Shijitan Hospital, 100038 Beijing, China.
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Qiao
authors.affiliation: First Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 200438 Shanghai, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Yan
authors.affiliation: Department of Hepatobiliary Surgery, Jingmen First People's Hospital, 67, Xiangshan Avenue, 448000 Jingmen, Hubei Province, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Hepatobiliary Surgery, Jingmen First People's Hospital, 67, Xiangshan Avenue, 448000 Jingmen, Hubei Province, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Duan
authors.affiliation: First Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 200438 Shanghai, China. Electronic address: ehbhyyq@163.com.
authors.forename: Yi-Qun
authors.initials: YQ
authors.lastname: Yan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D002648:Child; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology*; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D055815:Young Adult