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Prognostic factors and optimal treatment strategy for intrahepatic nodular recurrence after curative resection of hepatocellular carcinoma

 Gi-Hong Choi  ;  Dong-Hyun Kim  ;  Chang-Moo Kang  ;  Kyung-Sik Kim  ;  Jin-Sub Choi  ;  Woo-Jung Lee  ;  Byong-Ro Kim 
 ANNALS OF SURGICAL ONCOLOGY, Vol.15(2) : 618-629, 2008 
Journal Title
Issue Date
Adult ; Aged ; Carcinoma, Hepatocellular/mortality ; Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/surgery* ; Carcinoma, Hepatocellular/therapy ; Catheter Ablation ; Chemoembolization, Therapeutic ; Disease Progression ; Female ; Hepatectomy ; Humans ; Liver Neoplasms/mortality ; Liver Neoplasms/pathology ; Liver Neoplasms/surgery* ; Liver Neoplasms/therapy ; Liver Transplantation ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Prognosis ; Retrospective Studies ; Survival Analysis ; Time Factors
Hepatocellular carcinoma ; Intrahepatic nodular recurrence ; Prognosis–Treatment modalities
BACKGROUND: Intrahepatic recurrence is a major problem after curative resection of hepatocellular carcinoma. However, the most effective treatments for patients with intrahepatic recurrence still remain unclear. In addition, the selection of various treatment modalities such as repeat resection, local ablation therapy, and transarterial chemoembolization is only applicable to patients with intrahepatic nodular recurrence.

METHODS: Of 353 patients who underwent curative resection, 97 patients with intrahepatic nodular recurrence were retrospectively studied. The prognostic factors for survival after recurrence and treatment modalities were analyzed. The patients were divided into two groups, a control group and a progression group, according to their response to initial treatment for recurrent tumors.

RESULTS: The 1-, 3-, and 5-year overall survival rates after recurrence in patients with intrahepatic nodular recurrence were 91.0%, 71.0%, and 37.5%, respectively. Multivariate analysis revealed that early recurrence (< or =12 months), Child-Pugh class B or C at diagnosis of recurrence, and serum albumin level of < or =3.5 g/dL at diagnosis of recurrence were poor prognostic factors for survival after recurrence. With regard to the response to the initial treatment, time to recurrence of < or =12 months was found to be the only statistically significant risk factor for progression of disease in multivariate analysis.

CONCLUSIONS: Time to recurrence, which usually corresponds with the cellular origin of recurrence, seems to be more important when determining the prognosis of patients with recurrent disease and treatment response than treatment modality. Therefore, different treatment methods should be selected according to the time to recurrence of intrahepatic nodular recurrence.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Kim, Kyung Sik(김경식) ORCID logo https://orcid.org/0000-0001-9498-284X
Kim, Dong Hyun(김동현)
Lee, Woo Jung(이우정) ORCID logo https://orcid.org/0000-0001-9273-261X
Choi, Gi Hong(최기홍) ORCID logo https://orcid.org/0000-0002-1593-3773
Choi, Jin Sub(최진섭)
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