title: Risk factors and patterns of early recurrence after curative hepatectomy for hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) often recurs after curative hepatectomy; and early recurrence after hepatectomy (ERAH) is associated with poor prognosis. This study aimed to clarify risk factors and disease patterns for ERAH.
  
  
  METHODS
  We retrospectively analyzed clinicopathological factors of 232 patients who underwent initial curative hepatectomies for HCC between April 2000 and March 2013, and examined associated risk factors and early recurrence patterns by liver function status (as indicated by indocyanine green retention rate at 15 min [ICGR15]).
  
  
  RESULTS
  Patients who experienced recurrence within 6 months after hepatectomy (i.e., ERAH) had significantly shorter survival than those with longer disease-free intervals (P < 0.001). In multivariate analysis, microvascular invasion (mVI; P = 0.034) and ICGR15 ≥ 16% (P = 0.010) were independent risk factors for ERAH. In the ICGR1<16% subgroup, positive L3-AFP (P = 0.04), tumor size ≥ 5 cm (P = 0.011), surgical margin = 0 (P = 0.0103), mVI (P = 0.034), and extrahepatic recurrence were significant predictors of ERAH; in the ICGR15 ≥ 16%, subgroup, multiple tumors (P = 0.046) were identified as a risk factor for ERAH; however, this group did not experience much extrahepatic recurrence.
  
  
  CONCLUSIONS
  ERAH was associated with mVI and ICGR15 ≥ 16%. Recurrence patterns and risk factors vary by liver function status, which should be considered in forming management strategies for early recurrence of HCC after curative hepatectomy.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Japan. Electronic address: sur122@poh.osaka-med.ac.jp.
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Hirokawa
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Asakuma
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Japan.
authors.forename: Tetsunosuke
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007208:Indocyanine Green; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
chemical_list: D007208:Indocyanine Green
keywords: Early recurrence; Hepatocellular carcinoma; ICGR15; Indocyanine green retention rate at 15 min; Microvascular invasion; Treatment strategy