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BACKGROUND:Tumor resection in non-metastatic hepatocellular carcinoma(HCC)patients with adequate liver reserve offers a potential cure,but has a high 5-year recurrence rate.We analyzed the patterns of cancer relapse after partial hepatectomy to guide post-operative management.METHODS:A total of 144 HCC patients(1996-2011)after partial hepatectomy were reviewed.Statistical correlations were determined using univariate and partition analyses.RESULTS:A median follow-up of 20 months showed recurrence in 71(49%)patients,and the median time to recurrence was 11.9 months.Vascular invasion(P<0.01)and number of lesions(P<0.01)predicted for recurrence.Histologic grade was not correlated with recurrence.Twenty-two(31%)patients developed both surgical margin(SM)and concurrent intrahepatic recurrences,and 28(40%)had non-SM intrahepatic recurrences with no other signs of recurrence.On partition analysis,the risk of marginal recurrence in patients with SM<1 mm and SM≥1 mm was 35%and 13.5%respectively.Approximately 57%of patients with intrahepatic recurrence had recurrence≤2.5 cm from SM.CONCLUSIONS:Intrahepatic recurrence after partial hepatectomy is common and is significantly associated with vascular invasion and tumor stage.About 57%of patients with intrahepatic relapse had a recurrence close(≤2.5 cm)to the SM.Additionally,patients with SM<1 mm have a higher recurrence rate and may benefit from adjuvant local therapy.
BACKGROUND: Tumor resection in non-metastatic hepatocellular carcinoma (HCC) patients with adequate liver reserve offers a potential cure, but has a high 5-year recurrence rate. We analyzed the patterns of cancer relapse after partial hepatectomy to guide post-operative management. METHODS: A total of 144 HCC patients (1996-2011) after partial hepatectomy were reviewed. Statistical correlations were determined using univariate and partition analyzes .RESULTS: A median follow-up of 20 months showed recurrence in 71 (49%) patients, and The median time to recurrence was 11.9 months. Vascular invasion (P <0.01) and number of lesions (P <0.01) predicted for recurrence. Histologic grade was not correlated with recurrence. Twenty-two SM and concurrent intrahepatic recurrences, and 28 (40%) had non-SM intrahepatic recurrences with no other signs of recurrence. On Partition analysis, the risk of marginal recurrence in patients with SM <1 mm and SM ≥ 1 mm was 35% and 13.5% respective ly.Approximately 57% of patients with intrahepatic recurrence had recurrence ≤ 2.5 cm from SM.CONCLUSIONS: Intrahepatic recurrence after partial hepatectomy is common and is significantly associated with vascular invasion and tumor stage. About 57% of patients with intrahepatic relapse had a recurrence close (≤2.5 cm) to the SM. Additionally, patients with SM <1 mm have a higher recurrence rate and may benefit from adjuvant local therapy.