Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy.

By H. Imamura, Y. Matsuyama, E. Tanaka, T. Ohkubo, K. Hasegawa, S. Miyagawa, Y. Sugawara, M. Minagawa, T. Takayama, S. Kawasaki and 1 more. Journal of Hepatology, 2003

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BACKGROUND/AIMS We conducted a retrospective cohort study to investigate factors to early and late phase recurrence of hepatocellular carcinoma (HCC). METHODS The study population consisted of 249 patients including 157 with cirrhosis who underwent hepatectomy for HCC. The endpoint was time-to-recurrence. Using a Cox regression model, factors to early and late phase recurrences were investigated censoring recurrence-free patients at the 2-year time point and in patients without recurrence at 2 years. RESULTS Actuarial probability of overall recurrence at 1, 3, and 5 years were 0.301, 0.623, and 0.790, respectively, with a median follow-up of 624 days. Early recurrence was observed in 123 out of 249 patients; while late recurrence was found in 61 out of 113 patients. Factors to early recurrence were as follows: non-anatomical resection, presence of microscopic vascular invasion, and serum alpha-fetoprotein level >or=32 ng/ml. Those contributing to late phase recurrence were higher grade of hepatitis activity, multiple tumors, and gross tumor classification. CONCLUSIONS Variables associated with metastatic recurrence were factors to early phase recurrence; whereas those related with elevated carcinogenesis contributed to late phase recurrence, thus providing an epidemiological evidence that different mechanisms, i.e. metastasis and de novo, are involved in intrahepatic recurrence after hepatectomy for HCC.

Subfields: Hepatology, Oncology, Surgery

View Paper: https://www.semanticscholar.org/paper/4d59826030a367b45c30aa8ef5875d60e7fb3ef8

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Citations in the corpus

A Unique Metastasis Gene Signature Enables Prediction of Tumor Relapse in Early Stage Hepatocellular Carcinoma Patients (2010, positive): “early recurrence is associated with nonanatomic resection, microscopic vascular invasion, and high alpha fetoprotein (AFP) levels (14).”
Integrative Transcriptome Analysis Reveals Common Molecular Subclasses of Human Hepatocellular Carcinoma (2009, background): “We were careful to analyze the two major patterns of HCC recurrence: early recurrence, which is related to residual dissemination of primary tumor cells within the liver, and late recurrence, which is attributable to new primary tumors arising in a hypercarcinogenic state of a cirrhotic liver (17, 1”
Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: Subanalyses of a phase III trial , (2012, background): “therapies [1,2], and up to 70% of patients who undergo these procedures will have recurrent disease within 5 years and reach a more advanced tumor stage [4,5].”
Management of hepatocellular carcinoma: An update (2011, neutral): “Risk of Recurrence After resection, tumor recurrence rate exceeds 70% at 5 years(27,243,247-250) including recurrence due to dissemination and de novo tumors.(251,252) The most powerful predictors of recurrence are the presence of microvascular invasion and/or additional tumor sites besides the prim”
Novel advancements in the management of hepatocellular carcinoma in 2008. (2008, background): “Imamura [57] Early recurrence (<2 yr) 123 Vascular invasion AFP levels Non-anatomical resection Late recurrence (>2 yr) 61 Multinodular Hepatitis activity HCC gross classification”
Hepatocellular carcinoma: a review (2016, background): “Predictors of early recurrence include AFP levels >2,000 ng/dL, nonanatomic resection, micro- or macrovascular invasion, positive resection margins, and poorly differentiated tumors.(104) While de novo tumor development can occur after resection, the majority of HCC recurrences occurs within 1–2 yea”
Current Strategy for Staging and Treatment: The BCLC Update and Future Prospects (2010, background): “Recurrence during follow-up is frequent after resection and ablation as it affects more than 70% at 5 years.(36) Early recurrence before 2 years is conventionally attributed to dissemination; recurrence beyond this time point may be more likely due to metachronic HCC in the oncogenic cirrhotic liver”
EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. (2012, methodology): “No clinical definition of both entities has been established, but the cut-off of 2 years has been adopted to grossly classify early and late recurrences [149,198].”
EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. (2012, methodology): “No clinical definition of both entities has been established, but the cut-off of 2 years has been adopted to grossly classify early and late recurrences [149,198].”