BACKGROUNDThe authors evaluated the significance of the preoperative serum C‐reactive protein (CRP) level as a prognostic indicator in patients with hepatocellular carcinoma (HCC).METHODSOne hundred forty‐one patients who underwent curative resection for HCC were reviewed retrospectively. Clinicopathologic variables were compared between patients with serum CRP levels ≥ 1.0 mg/dL (n = 22 patients; the CRP‐positive group) and patients with serum CRP levels < 1.0 mg/dL (n = 119 patients; the CRP‐negative group). Univariate and multivariate analyses were conducted to identify factors that affected survival and disease recurrence.RESULTSThere was a significant correlation between the preoperative serum CRP level and tumor size. Invasion to the portal vein in the CRP‐positive group was significantly more frequent than that in the CRP‐negative group. Even after they underwent curative resection, 75.3% of patients in the CRP‐positive group experienced recurrence within 1 year. The overall survival and recurrence‐free survival rates in the CRP‐positive group were significantly lower compared with the rates in the CRP‐negative group. On multivariate analysis, the preoperative serum CRP level was selected as one of the unfavorable indicators regarding survival and recurrence. When CRP levels, albumin levels, and platelet counts that were available before surgery were scored as a combined index, the total score demonstrated a good stratification value for survival after hepatic resection.CONCLUSIONSThe current results showed that the preoperative serum CRP level is an independent and significant indicator predictive of poor prognosis and early recurrence in patients with HCC. The new CRP‐based scoring system offers reliable information for predicting survival. Cancer 2005. © 2005 American Cancer Society.

This retrospective, multi-institutional analysis showed that, in patients who undergo curative hepatectomy for HCC, the preoperative CONUT score is predictive of worse OS and RFS, even after propensity score matching analysis.

We evaluated the effect of diabetes mellitus on the prognosis of hepatocellular carcinoma after an elective hepatic resection. Of the 342 patients who underwent a hepatic resection between April 1985 and March 1995, 87 (25.4%) were diabetic. Postoperative morbidity was more common among diabetics than among nondiabetics (36.0% vs. 22.5%, P ‫؍‬ .0239). The postoperative survival rate and the cancer-free survival rate were also better in patients without diabetes than in those with diabetes (P ‫؍‬ .0333, P ‫؍‬ .0149). The results of a multivariate analysis show diabetes mellitus to be an independent and prognostic indicator after a hepatic resection with hepatocellular carcinoma. According to the above findings, diabetes mellitus is thus considered to be a risk factor for prognosis after hepatic resection in patients with hepatocellular carcinoma. (HEPATOLOGY 1998;27:1567-1571.)The influence of diabetes mellitus on the outcome of elective surgical procedures remains controversial. [1][2][3][4] We previously reported that diabetic patients who underwent elective hepatic resections developed a higher incidence of postoperative morbidity, but not a shorter long-term survival. 5,6 Recently, Adami et al. 7 reported diabetes mellitus to be a risk factor for carcinogenesis in primary liver cancer based on a cohort study. However, little proof has been found regarding the effect of diabetes mellitus on the long-term outcome of patients with hepatcellular carcinoma after a hepatic resection. Therefore, the purpose of this study is to clarify the effect of diabetes mellitus on the long-term survival after a hepatic resection for hepatocellular carcinoma. PATIENTS AND METHODSBetween April 1985 and March 1995, 342 patients with hepatocellular carcinoma underwent a curative hepatic resection in the department of Surgery II, Kyushu University Hospital and affiliated hospitals. They ranged in age from 33 to 79 years (mean Ϯ SD, 59.7 Ϯ 8.3 years), and 275 (80.4%) were males. Liver cirrhosis was identified in 183 patients (53.5%). The methods of resection used included a trisegmentectomy in eight patients, a lobectomy in 84, a segmentectomy in 52, a subsegmentectomy in 64, and a partial hepatectomy consisting of less than a subsegmentectomy in 134. The follow-up period ranged from 34 to 4,036 days (median, 1,278 days; 25th percentile, 724 days; 75th percentile, 2,012 days).Of these patients, 87 (25.4%) were diagnosed with diabetes. The definition of diabetes mellitus was a fasting serum glucose above 7.8 mmol/L (140 mg/dL), abnormal results for a 75-g oral glucose tolerant test, or the need for insulin or an oral antihyperglycemic drug to control glucose levels. The preoperative control of diabetes mellitus was done either by diet alone or in combination with subcutaneous injections of insulin to maintain the fasting glucose below 8.3 mmol/L (150 mg/dL) and the 24-hour urinary glucose excretion below 10 g.The preoperative, intraoperative, and postoperative variables in the patients who underwent a hepatic resection with (HCC) were...

With the technical standardization, LS becomes a feasible and safe approach in the setting of liver cirrhosis and portal hypertension.

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