title: Liver resection for early hepatocellular cancer: Comparison of centers in 3 different countries.
abstract: OBJECTIVE
  To compare patients who underwent resection of early stage hepatocellular cancer (HCC) in three different countries.
  
  
  METHODS
  This retrospective study characterizes 573 stage I/II HCC patients treated with liver resection in 3 tertiary-referral centers: Tokyo (n= 250), Honolulu (n= 146) and Shanghai (n= 177).
  
  
  RESULTS
  Shanghai patients were younger, predominantly male, hepatitis-B seropositive (94%) and cirrhotic (93%). Tokyo patients were older and more likely to have hepatitis-C (67%), smaller tumors, low albumin, and normal alpha-fetoprotein. The Honolulu cohort had the largest tumors and 30% had no viral hepatitis. Age-adjusted mortality at 1 and 5-years were lower in the Tokyo cohort compared to Honolulu and there was no difference in mortality between Shanghai and Honolulu cohorts. Elevated alpha-fetoprotein, low albumin and tumor > 5 cm were associated with increased 1-year mortality. These factors and cirrhosis were independently associated with increased 5-year mortality. Independent risk factors of survival varied when examined separately by center.
  
  
  CONCLUSIONS
  The profile of early-stage HCC patients is strikingly different across countries and likely contributes to survival differences. Underlying differences in patient populations including risk factors/comorbidities influencing disease progression may also account for variation in outcomes.
authors.affiliation: Linda L Wong, Brenda Y Hernandez, Yurii B Shvetsov, Cancer Center, Department of Surgery, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, United States.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wong
authors.affiliation: Linda L Wong, Brenda Y Hernandez, Yurii B Shvetsov, Cancer Center, Department of Surgery, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, United States.
authors.forename: Brenda Y
authors.initials: BY
authors.lastname: Hernandez
authors.affiliation: Linda L Wong, Brenda Y Hernandez, Yurii B Shvetsov, Cancer Center, Department of Surgery, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, United States.
authors.forename: Yurii B
authors.initials: YB
authors.lastname: Shvetsov
authors.affiliation: Linda L Wong, Brenda Y Hernandez, Yurii B Shvetsov, Cancer Center, Department of Surgery, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, United States.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Kawano
authors.affiliation: Linda L Wong, Brenda Y Hernandez, Yurii B Shvetsov, Cancer Center, Department of Surgery, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, United States.
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
authors.affiliation: Linda L Wong, Brenda Y Hernandez, Yurii B Shvetsov, Cancer Center, Department of Surgery, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, United States.
authors.forename: Jun-Fang
authors.initials: JF
authors.lastname: Ji
keywords: Hepatocellular cancer; Liver resection; Viral hepatitis