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Recurrent hepatocellular carcinoma has an increased risk of subsequent recurrence after curative treatment
Author(s) -
Yamashiki Noriyo,
Yoshida Haruhiko,
Tateishi Ryosuke,
Shiina Shuichiro,
Teratani Takuma,
Yoshida Hideo,
Kondo Yuji,
Oki Takamasa,
Kawabe Takao,
Omata Masao
Publication year - 2007
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2006.04732.x
Subject(s) - medicine , hepatocellular carcinoma , hazard ratio , proportional hazards model , radiofrequency ablation , gastroenterology , multivariate analysis , retrospective cohort study , carcinoma , surgery , ablation , confidence interval
Background and Aim: Local ablation therapy has been shown to be effective for small hepatocellular carcinoma (HCC); however, HCC recurrence is very frequent even after apparently curative treatment. In particular, recurrent HCC may be more prone to subsequent recurrence, although quantitative data are lacking. The aim of this study was to evaluate the difference in the risk for subsequent recurrence, if any, between primary and recurrent cases. Methods: A retrospective analysis was conducted of 376 patients with HCC (uninodular and ≤5 cm, or 2–3 nodules each ≤3 cm) who underwent local ablation therapy. There were 207 primary cases (group I), 100 with first recurrence (group II), and 69 with second or later recurrence (group III). After confirming complete ablation, each patient was followed up for recurrence. Risk factors for recurrence‐free survival were analyzed using proportional hazard regression. Results: The median time to recurrence, as estimated by Kaplan–Meier method, was 30 months in group I, 23 months in group II, and 11 months in group III ( P < 0.001). Multivariate proportional hazard regression analysis reveled that group (i.e. previous recurrence) was the strongest predictor of subsequent recurrence; compared to group I, group II showed a hazard ratio of 1.456 ( P = 0.015) and group III, 3.011 ( P < 0.0001). α‐Fetoprotein level >100 ng/mL, treatment other than radiofrequency ablation, HCV antibody positivity, and tumor multinodularity also remained as significant predictors. Conclusion: Hepatocellular carcinoma at second or later recurrence is three times as prone to subsequent recurrence as is primary HCC, when compared with adjustment for other tumor and hepatic factors.