The median time to recurrence was 31.6 months with a 5-year recurrence rate of 68% (Fig. 1B). Approximately 80% of the deaths were preceded by recurrence. The instantaneous risk of death and cancer recurrence over time are demonstrated in Fig. 1C. Variables significantly associated with recurrence on univariate and multivariate analyses are outlined in Tables 2 and 3. The variables significantly associated with time

to recurrence for the entire cohort included presence of satellites (HR, 2.79; P = 0.003), cirrhosis (HR, 2.3; P = 0.010), and nonanatomic resection (HR, 1.79; P = 0.031). Other relevant clinical variables that did not reach statistical significance on univariate analysis for recurrence are listed in Supporting Table 1. At 1 year, there had been 20 instances of Selleckchem CP-673451 “very early” GSK-3 beta pathway recurrence with a rate of 17%. At 2 years there had been 38 recurrences resulting in a rate of 29%. Variables significantly associated with recurrence at 1 and 2 years on univariate and multivariate analysis are listed in Tables 3 and 4. All but one of the 67 patients with recurrent tumor underwent treatment, either

with a single modality or a combination of therapies. Treatments included transarterial chemoembolization (n = 38), percutaneous ethanol ablation (n = 3), Yttrium90 radioembolization (n = 1), liver transplantation (n = 6), repeated hepatic resection (n = 21), RFA (n = 17), sorafenib (n = 2), and resection of extrahepatic tumor (lung = 1, omentum = 1). Several other findings deserve specific mention. Etiology of underlying liver disease did not correlate with survival or recurrence. Laparoscopic resection was Thiamine-diphosphate kinase performed in 15 (11%) cases and also did not alter these endpoints. There was no relationship between the location of the tumor and the type of resection (anatomic versus nonanatomic). However, we did find a correlation between nonanatomic resection and platelet count

<100,000/μL and/or bilirubin >1 mg/dL, probably in an attempt to preserve functioning parenchyma. Of the two variables found to be significantly associated with survival on multivariate analysis, only platelet count is available preoperatively to help guide patient selection. If resection was limited only to the 66 patients with platelet count ≥150,000/μL, as determined by ROC curve analysis, the median survival increased to 138 months, and the 5-year survival rate increased to 81% (Fig. 2A). Likewise, the only variable significantly associated with recurrence that can be controlled by the clinician is the type of resection that is performed. Performing anatomic resection was associated with a 20% decrease in the recurrence rate from 80% down to 60% at 5 years (Fig. 2B). Patients with Metavir stage 4 fibrosis were chosen in order to analyze results in the cirrhosis subgroup (n = 89, 67% of the overall series). The median survival and 5-year survival rate in this group were 67.1 months and 63%, respectively.