Send to

Choose Destination
World J Hepatol. 2016 Nov 8;8(31):1327-1335.

Liver resection for early hepatocellular cancer: Comparison of centers in 3 different countries.

Author information

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.



To compare patients who underwent resection of early stage hepatocellular cancer (HCC) in three different countries.


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).


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.


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.


Hepatocellular cancer; Liver resection; Viral hepatitis

Conflict of interest statement

Conflict-of-interest statement: Dr Wong is a speaker for Bayer Healthcare. The other authors have no conflicts of interest to declare.

Supplemental Content

Full text links

Icon for Baishideng Publishing Group Inc. Icon for PubMed Central
Loading ...
Support Center