Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

The Risk Factors for the Intrahepatic Recurrence of Hepatocellular Carcinoma after Curative Resection

간세포암의 근치적 절제 후 간내 재발암의 위험 인자 분석

  • Kim, Gang-Mi (Department of Surgery, Yonsei University Health System) ;
  • Choi, Gi-Hong (Department of Surgery, Yonsei University Health System) ;
  • Han, Dai-Hoon (Department of Surgery, Yonsei University Health System) ;
  • Kim, Dong-Hyun (Department of Surgery, Yonsei University Health System) ;
  • Kang, Chang-Moo (Department of Surgery, Yonsei University Health System) ;
  • Choi, Jin-Sub (Department of Surgery, Yonsei University Health System) ;
  • Park, Jun-Yong (Department of Internal Medicine, Yonsei University Health System) ;
  • Kim, Do-Yong (Department of Internal Medicine, Yonsei University Health System) ;
  • Han, Kwang-Hyub (Department of Internal Medicine, Yonsei University Health System) ;
  • Chon, Chae-Yoon (Department of Internal Medicine, Yonsei University Health System) ;
  • Park, Young-Nyun (Department of Pathology, Yonsei University Health System) ;
  • Lee, Woo-Jung (Department of Surgery, Yonsei University Health System)
  • 김강미 (연세대학교 외과학 교실) ;
  • 최기홍 (연세대학교 외과학 교실) ;
  • 한대훈 (연세대학교 외과학 교실) ;
  • 김동현 (연세대학교 외과학 교실) ;
  • 강창무 (연세대학교 외과학 교실) ;
  • 최진섭 (연세대학교 외과학 교실) ;
  • 박준용 (연세대학교 내과학 교실) ;
  • 김도영 (연세대학교 내과학 교실) ;
  • 한광협 (연세대학교 내과학 교실) ;
  • 전재윤 (연세대학교 내과학 교실) ;
  • 박영년 (연세대학교 병리학 교실) ;
  • 이우정 (연세대학교 외과학 교실)
  • Published : 2008.12.30

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Abstract

Purpose: Intrahepatic recurrent HCC has been classified according to location, the time to recurrence and the pattern of presentation. The purpose of this study is to classify intrahepatic recurrent HCCs into subgroups that have relatively similar recurrent patterns and to identify the risk factors for each recurrent type. Methods: A total of 353 patients were retrospectively studied. Intrahepatic recurrent HCC was classified into nodular recurrence (<4 nodules; type I), multinodular-diffuse recurrence (${\geq}$4 nodules; type II) and infiltrative recurrence (type III). The cut-off time between early and late recurrence was chosen to be 12 months following hepatectomy. Results: Among the 134 patients with only intrahepatic recurrence, 94 were type I, 27 were type II and 13 were type III. The median survival time following the recurrence of types I, II and III were 55, 16 and 8 months, respectively. As determined by multivariate analysis, perioperative transfusion and indocyanine green retention at 15 minutes (ICG R 15 >10%) were the independent risk factors for type I; an ICG R 15>10%, microvessel invasion and intrahepatic metastasis were the independent risk factors for type II; an ICG R 15>10% and microscopic portal vein invasion were the independent risk factors for type III. Multivariate analysis revealed that the prognosis of patients with IHR was associated with the recurrent types, the time to recurrence and the serum albumin level at the initial presentation. Following multivariate analysis, an ICG R 15>10% and intrahepatic metastasis were the independent risk factors for early type I recurrence; perioperative transfusion and a higher grade of hepatitis activity were the independent risk factors for late type I recurrence. Conclusions: The recurrent types and the time to recurrence may help us to predict the cellular origin of intrahepatic recurrent HCC and the prognosis of the patients who suffer with intrahepatic recurrent HCC.

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