Predicting Hepatocellular Carcinoma Recurrence Beyond Milan Criteria After Liver Resection for Solitary Hepatocellular C
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ORIGINAL ARTICLE
Predicting Hepatocellular Carcinoma Recurrence Beyond Milan Criteria After Liver Resection for Solitary Hepatocellular Carcinoma Jong Man Kim 1 & Jae-Won Joh 1 Kyung-Suk Suh 2
&
Nam-Joon Yi 2 & Gyu-Seong Choi 1 & Kyunga Kim 3 & Kwang-Woong Lee 2 &
Received: 20 May 2019 / Accepted: 6 August 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background and Purpose Several hepatectomy patients with HCC who are initially transplantable (within MC) developed untransplantable HCC recurrence (beyond MC) after primary curative liver resection. The purpose of our study is to identify the risk factors of untransplantable hepatocellular carcinoma (HCC) recurrence after primary curative resection of solitary HCC and solitary HCC within Milan criteria (MC). Methods We retrospectively reviewed 592 patients with recurrent HCC who underwent liver resection due to solitary HCC between 2005 and 2011. Results All patients were Child-Pugh class A. At primary curative hepatectomy, 411 patients (69.4%) were diagnosed with HCC within MC and 181 patients (30.6%) had HCC beyond MC. The mean time from primary hepatectomy to recurrence was 14 months (range, 1–116 months). At HCC recurrence, 93 patients (15.7%) were diagnosed beyond MC. Multivariate analysis showed that microvascular invasion and a tumor grade of 3 or 4 were closely associated with a high risk of HCC recurrence beyond MC in patients who had hepatectomy for solitary HCC. Of the 411 patients within MC at primary curative hepatectomy, 54 patients (13.9%) developed HCC recurrence beyond MC. Multivariate analysis also showed that microvascular invasion and a tumor grade of 3 or 4 were closely associated with HCC recurrence beyond MC in these patients. Conclusions The present study suggests that the presence of certain unfavorable histological factors in patients who underwent initial liver resection of transplantable HCC within MC with good liver function predicted the development of recurrent HCC beyond MC. Keywords Hepatocellular carcinoma . Milan criteria . Hepatectomy . Tumor recurrence . Liver transplantation
Abbreviations MC Milan criteria HBV Hepatitis B virus HCV Hepatitis C virus NBNC Non-B non-C
* Jae-Won Joh [email protected] 1
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul 06351, South Korea
2
Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
3
Department of Biostatics, Samsung Medical Center, Seoul, Republic of Korea
AST ALT AFP PIVKA-II INR ICG HCC TACE RFA PEI LT LR PVTT PET MRI
Aspartate transaminase Alanine transaminase Alpha-fetoprotein Protein induced by vitamin K absence or antagonist-II International normalized ratio Indocyanine green retention test at 15 min Hepatocellular carcinoma Transarterial chemoembolization Radiofrequency ablation Percutaneous ethanol injection Liver transplantation Liver resection Portal vein tumor thrombosis Positron emission tomography Magne
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