Risk factors for immediate post-operative fatal recurrence after curative resection of hepatocellular carcinoma

Table 1 Univariate analysis of host factors for immediate post-operative diffuse intra-hepatic recurrence or multiple distant recurrence after curative resection for HCC

Host factor	Patients (%) or (mean ± SD)		P
	Fatal recurrence group	Control group
Sex, male (%)	76	74	NS
Mean age(yr)	49.2 ± 9.9	52.1 ± 10.4	NS
HCC-related symptom	50	31	0.04
Child’s classification A/B/C	90/10/0	90/9/1	NS
ICG R-15 (%)	14.6  ±  11.3	13.4  ±  8.6	NS
Serum ALT (nkat/L)	1185  ± 1285	1034  ±  944	NS
Serum AST (nkat/L)	1649  ± 1259	1125 ± 1539	NS
HBs Ag positivity	77	74	NS
HCV Ab positivity	13	8.4	NS
Serum AFP level (μg/L)	10 447.4 ± 12 931.9	23045  ± 6 660	0.00
Histologic grade of hepatitis 0, 1, 2/3, 41	86.7/13.3	92.8/7.2	NS
Histologic stage of cirrhosis 0, 1, 2/3, 41	15.8/84.2	19.2/80.8	NS

¹Data in each parameter showed less than 2% missing rate, but histologic grade of hepatitis and histologic stage of cirrhosis showed 9% and 10.5% data missing rate, respectively.

Table 2 Univariate analysis of tumor and surgical factors for immediate post-operative diffuse intra-hepatic recurrence or multiple distant recurrence after curative resection of HCC

	Patients(%) or (mean ± SD)
	Fatal recurrence group	Control group	P
Tumor factors
Tumor size (cm)	10.1 ± 6.2	4.8 ± 3.2	0.00
Tumor growth pattern, Eg1/Ig2	36.7/63.3	7.9/92.1	0.00
Multiple tumors	60.0	28.5	0.01
Tumor capsule formation	66.7	81.4	NS
Tumor capsule infiltration	45.0	29.6	NS
Intra-tumor septum formation	6.7	6.7	NS
Gross vascular or duct invasion	23.3	6.2	0.01
Microvascular invasion	86.6	33.9	0.00
Glisson’s capsule invasion	70.0	29.8	0.00
Edmond–Steiner grade I, II/III, IV Surgical factors 3	47.4/52.6	40.7/59.3	NS
Anatomical resection	93.3	87.8	NS
Resection margin ≥ 1 cm	66.7	42.3	0.02

¹Expanding growth pattern;

²Infiltrative growth pattern;

³Data in each parameter showed less than 2% missing data rate, but there was 11.5% missing rate in the Edmond-Steiner grade.

Table 3 Multivariate analysis of significant risk factors for immediate postoperative diffuse intrahepatic recurrence or multiple distant recurrence after curative resection of HCC

Risk factors	Odds ratio	Standard error	P
Microvascular invasion	4.89	0.62	0.01
AFP ≥ 1 000 ng/mL	2.98	0.46	0.02
Tumor size ≥ 6.5 cm	2.98	0.50	0.03

Table 4 Predictive values of risk factors for fatal recurrence after curative resection of HCC

	n	Number of fatalrecurrence1	PPV(%)	NPV(%)	Test efficiency (%)	P2
All three risk factors present	27	13	48.1	92.9	88.5	0.023
Only two risk factors present	50	11	22.0	91.3	78.4	0.023
Microvascular invasion and tumor size ≥ 6.5 cm	26	6	23.1	90.1	83.6	0.027
Microvascular invasion and AFP ≥ 1 000 ng/mL	21	4	19.0	89.5	84.0	0.027
Tumor size ≥ 6.5 cm and AFP ≥ 1 000 ng/mL	3	1	33.3	89.1	88.5	0.027
Only one risk factor present	71	5	7.0	87.4	66.2	0.027
Micro-vascular invasion	33	3	9.1	88.6	78.8	0.027
Tumor size ≥ 6.5 cm	15	1	6.7	88.6	84.0	0.027
AFP ≥ 1 000 μg/L	23	1	4.3	88.2	81.1	0.027
No risk factor present	121	1	0.8	80.4	44.6	0.027
Number of total patients	269	30				0.027

PPV: positive predictive value; NPV: negative predictive value;

¹Number of patients with fatal recurrence within 6 mo of surgery; ²Statistical difference of PPV between patients with fatal recurrence within 6 months of surgery according to number of risk factors in each group.