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J Surg Oncol. 2010 Feb 1;101(2):105-10. doi: 10.1002/jso.21461.

Factors associated with recurrence and survival following hepatectomy for large hepatocellular carcinoma: a multicenter analysis.

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Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky 40202, USA.



Optimal management of large (>5 cm) hepatocellular carcinoma (HCC) remains controversial. We sought to determine the factors associated with recurrence and survival for patients with large HCC following hepatectomy.


An analysis of a combined prospective database from two tertiary care centers was performed on consecutive patients who underwent hepatectomy for HCC > 5 cm. Univariate and multivariate analyses were performed to determine factors associated with recurrence, disease-free (DFS) and overall survival (OS).


Seventy-eight patients were identified: 32 (41%) had hepatic fibrosis. Forty-six patients (59%) underwent a major hepatectomy with a morbidity rate of 41% and a mortality rate of 13%. Fibrosis was associated with male gender (P = 0.045), hepatitis C (P = 0.003), higher Child-Pugh (P < 0.0001) and Okuda score (P = 0.002), smaller tumors (6.25 cm vs. 10.5 cm; P < 0.001), positive-margin resection (P = 0.01), and death (P = 0.047). Factors associated with recurrence include tumor multifocality (P = 0.03) and vascular invasion (P = 0.02). Predictors of OS include multifocal tumors (P = 0.05), margin status (P = 0.02), vascular invasion (P = 0.01), and treatment complications (P = 0.004). The median overall DFS and OS were 12 and 20 months, respectively. Fibrosis had no impact on DFS (P = 0.24) or OS (P = 0.20).


For patients with HCC larger than 5 cm, tumor-related factors predict outcomes and survival.

[Indexed for MEDLINE]

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