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Analysis of the Risk Factors of Untransplantable Recurrence After Primary Curative Resection for Patients with Hepatocellular Carcinoma

Annals of Surgical Oncology volume 20, pages 2526–2533 (2013)Cite this article

Abstract

Purpose

To determine the prognostic factors that predict recurrence of hepatocellular carcinoma (HCC) exceeding the University of California at San Francisco (UCSF) criteria after primary resection.

Methods

HCC patients who underwent curative liver resections between 2001 and 2007 and who were within the UCSF criteria (n = 716) were examined. Independent prognostic factors were examined by the Cox proportional hazard model.

Results

A total of 285 patients (39.8 %) developed recurrences. Of the patients who developed recurrences, 180 had HCC still within the UCSF criteria (63.2 %), and 105 developed HCC beyond this criteria (36.8 %). Among the population with primary transplantable HCC, patients with larger primary tumor sizes, serum α-fetoprotein (AFP) levels over 400 ng/mL, satellite nodules, vascular invasion, or undifferentiated HCC had a risk of untransplantable recurrence, as shown by univariate analysis. In multivariate analysis, undifferentiated HCC and vascular invasion were identified as the significant predictors with adjusted hazard ratios of 9.25 [95 % confidence interval (CI) 2.13–40.21] and 2.19 (95 % CI 1.34–3.58), respectively. When only preoperative factors were considered in multivariate analysis, primary tumor size and serum AFP levels over 400 ng/mL were identified as significant predictors with adjusted hazard ratios of 1.24 (95 % CI 1.07–1.45) and 1.72 (95 % CI 1.05–2.82), respectively.

Conclusions

For primary HCC patients within the UCSF criteria, larger tumor sizes and AFP levels over 400 ng/mL were associated with postresection recurrence of HCC exceeding the UCSF criteria. Because these are clearly markers for aggressive tumor biology, whether early primary transplant will alter the aggressive tumor behaviors warrant further investigation.

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Acknowledgment

We thank Dr. Wen-Yi Shau for statistical consultation.

Conflict of interest

The authors declare no conflict of interest.

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Affiliations

  1. Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan

    Cheng-Maw Ho MD, Chao-Ying Wu MD, Po-Huang Lee MD, PhD, Hong-Shiee Lai MD, PhD, Ming-Chih Ho MD, PhD, Yao-Ming Wu MD & Rey-Heng Hu MD, PhD

  2. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

    Cheng-Maw Ho MD & Po-Huang Lee MD, PhD

Authors
  1. Cheng-Maw Ho MD
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  2. Chao-Ying Wu MD
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  3. Po-Huang Lee MD, PhD
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  5. Ming-Chih Ho MD, PhD
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  6. Yao-Ming Wu MD
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Correspondence to Rey-Heng Hu MD, PhD.

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Cheng-Maw Ho and Chao-Ying Wu contributed equally to this article.

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Ho, CM., Wu, CY., Lee, PH. et al. Analysis of the Risk Factors of Untransplantable Recurrence After Primary Curative Resection for Patients with Hepatocellular Carcinoma. Ann Surg Oncol 20, 2526–2533 (2013). https://doi.org/10.1245/s10434-013-2940-7

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  • DOI: https://doi.org/10.1245/s10434-013-2940-7

Keywords

  • Liver Transplantation
  • Milan Criterion
  • Primary Resection
  • Microvascular Invasion
  • Satellite Nodule