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Comparison of Recurrence of Hepatocellular Carcinoma After Resection in Patients with Cirrhosis to Its Occurrence in a Surveilled Cirrhotic Population

  • Hepatobiliary and Pancreatic Tumors
  • Published:
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Abstract

The presence of cirrhosis is the only risk factor that is advocated for recurrence of hepatocellular carcinoma (HCC) 2 years after hepatic resection compared with noncirrhotic control subjects; however, data for cohorts of exclusively patients with cirrhosis are lacking. This study was designed to assess risk factors and annual incidence of early (<2 years) and late (>2 years) recurrence after resection of cirrhosis and to compare these findings with those of patients with cirrhosis enrolled in HCC surveillance programs (HCC occurrence). Data from 204 patients with cirrhosis resected for HCC and 150 surveilled for cirrhosis were retrospectively collected and compared using propensity score matching to overcome biases of nonrandomized study. Risk factors for early recurrence (incidence = 21.8%/year) were higher serum alpha-fetoprotein (AFP) levels, poorly differentiated tumor, and presence of microvascular invasion (P < 0.05). Risk factors for both late recurrence (18.4%/year) and HCC occurrence (3.3%/year) were male gender, older age, and higher serum transaminase levels; multiple primary tumors and higher AFP were additional risk factors for late recurrence and HCC occurrence respectively (P < 0.05). After propensity adjustment, resected patients with less than two risk factors for late recurrence showed an annual incidence of HCC (6.2%/year) similar to that of surveilled patients with ≥2 risk factors (5.8%/year; P = 0.898). Early and late recurrence of HCC for patients with cirrhosis after resection have distinct risk factors. Annual incidence of HCC 2 years or more after resection may be similar to that of general patients because the same risk factors are involved; assessment of these characteristics could be useful in tailoring clinical management.

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Acknowledgment

The authors thank Mrs. Marian Shields for assistance.

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Authors and Affiliations

  1. Department of Surgery and Transplantation, Policlinico Sant’Orsola-Malpighi, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy

    Alessandro Cucchetti MD, Marco Vivarelli MD, Giorgio Ercolani MD, Matteo Cescon MD, Matteo Ravaioli MD, Gian Luca Grazi MD & Antonio Daniele Pinna MD

  2. Department of Internal Medicine and Gastroenterology, Division of Internal Medicine, Policlinico Sant’Orsola-Malpighi, University of Bologna, Bologna, Italy

    Fabio Piscaglia MD & Luigi Bolondi MD

  3. Gastroenterology Unit, Belcolle Hospital, Viterbo, Italy

    Eugenio Caturelli MD

  4. Department of Internal Medicine, University of Padova, Padova, Italy

    Luisa Benvegnù MD

Authors
  1. Alessandro Cucchetti MD
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  2. Fabio Piscaglia MD
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  3. Eugenio Caturelli MD
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  4. Luisa Benvegnù MD
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  5. Marco Vivarelli MD
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  6. Giorgio Ercolani MD
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  7. Matteo Cescon MD
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  8. Matteo Ravaioli MD
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  9. Gian Luca Grazi MD
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  10. Luigi Bolondi MD
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  11. Antonio Daniele Pinna MD
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Correspondence to Alessandro Cucchetti MD.

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Cucchetti, A., Piscaglia, F., Caturelli, E. et al. Comparison of Recurrence of Hepatocellular Carcinoma After Resection in Patients with Cirrhosis to Its Occurrence in a Surveilled Cirrhotic Population. Ann Surg Oncol 16, 413–422 (2009). https://doi.org/10.1245/s10434-008-0232-4

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  • DOI: https://doi.org/10.1245/s10434-008-0232-4

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