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Histological subclassification of cirrhosis can predict recurrence after curative resection of hepatocellular carcinoma

Authors

  • Seung Up Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    4. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Kyu Sik Jung,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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  • Sarah Lee,

    1. Department of Pathology and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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  • Jun Yong Park,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    4. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Do Young Kim,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    4. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Sang Hoon Ahn,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    4. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
    5. Brain Korea 21 PLUS Project of Medical Science, Korea
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  • Gi Hong Choi,

    1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
    2. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Kyung Sik Kim,

    1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
    2. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Jin Sub Choi,

    1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
    2. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
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  • Kwang-Hyub Han,

    1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    2. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    3. Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
    4. Liver Cirrhosis Clinical Research Center, Yonsei University College of Medicine, Seoul, Korea
    5. Brain Korea 21 PLUS Project of Medical Science, Korea
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  • Young Nyun Park

    Corresponding author
    1. Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
    2. Department of Pathology and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
    3. Brain Korea 21 PLUS Project of Medical Science, Korea
    • Correspondence

      Young Nyun Park, MD, PhD, Department of Pathology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun–gu, Seoul 120-752, Korea

      Tel: +82–2–2228–1768

      Fax: +82–2–362–0860

      e-mail: young0608@yuhs.ac

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  • Seung Up Kim and Kyu Sik Jung have equally contributed to this work.

Abstract

Background

Recurrence of hepatocellular carcinoma (HCC) after curative resection continues to be a major cause of death. This prospective study is designed to investigate whether histological subclassification of cirrhosis using the Laennec system could predict recurrence in patients with hepatitis B virus (HBV)-related HCC after curative resection.

Methods

Patients with HBV-related HCC who underwent curative resection and showed Laennec stage 3 to 4 were enrolled and the cases with stage 4 were subclassified histologically into three groups (stages 4A, 4B and 4C) according to the Laennec system. Between February 2006 and August 2009, 92 patients were recruited.

Results

Stage 3, 4A, 4B and 4C were identified in 24 (26.1%), 15 (16.3%), 43 (46.7%) and 10 (10.9%) patients respectively. The cumulative incidence rates of recurrence at 1, 2 and 3 years were 24.2%, 40.5% and 55.1% respectively. On multivariate analysis, serum albumin [hazard ratio (HR), 0.528; 95% confidence interval (CI), 0.312–0.891; P = 0.017] and Edmondson–Steiner grade III–IV (HR, 3.456; 95% CI, 1.123–10.517; P = 0.031) were significantly correlated with early recurrence (<1 year), whereas stage 4C (HR, 5.426; 95% CI, 1.030–28.598; P = 0.046) was the only independent risk factor for late recurrence (≥1 year).

Conclusions

Histological subclassification of cirrhosis using the Laennec system is a significant predictor of late recurrence in patients with HBV-related HCC after curative resection.

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