Factors predisposing to poorly differentiated hepatocellular carcinoma and its recurrence

Background/Aims: We investigated the clinical factors predisposing moderately or poorly differentiated hepatocellular carcinoma and analyzed which clinical and histological factors are associated with poorly, differentiated hepatocellular carcinoma (HCC) recurrence. Methodology: Percutaneous fine-needle biopsy was taken from the liver tumor of 191 consecutive patients between January 1994 and September 1996., The histological,degree of differentiation of hepatocellular carcinoma at the first time of initial treatment and at the time of second recurrence was classified according to the criteria of Edmondson and Steiner. Results: At the time of the first therapy, 86 patients, 81, 24, and 0 patients had liver tumors classified as (Ed), 1, 2, 3, and 4, respectively. The prognosis of patients with Ed-3/4 HCC was, worse than and the tumor sizes were larger than that of Ed-1/2 HCC patients. Of the 167 patients classified as Ed-1/2 at the time of first therapy, HCC recurred in 95 of the patients during the mean follow-up period of 3.4 years. Multivariate analysis revealed that only tumor size (P=0.035) and TACE therapy (P=0.0009) were independently significant factors in predicting future Ed-3/4 or multiple HCC recurrence. Conclusions: Tumor size and TACE therapy were clinical predisposing factors for Ed-3/4 or multiple HCC recurrences.