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Tong et al. Hepatoma Res 2019;5:36 I http://dx.doi.org/10.20517/2394-5079.2019.005 Page 11 of 13

Figure 3. Recurrence-free survival in hepatocellular carcinoma patients with slow vs. fast tumor growth rate by treatment category. TGR:
tumor growth rate; OLT: orthotopic liver transplantation; RFA: radiofrequency ablation; TACE: transarterial chemoembolization

for diagnosis of early HCC. Future studies using TGR along with other imaging criteria will assist in this
endeavor.

There are limitations to our study. This was a retrospective analysis of HCC patients from a single community
specialty clinic. However all HCC treatments were performed at a university center where multi-disciplinary
subspecialities were active in the care of these patietns. This scenario is much more representative of the real
world setting since issues of long-term follow-up, financial constraints, and day to day care all came into play.
Also, patients who did not have a second imaging study prior to HCC treatments were excluded from our
analysis which may have biased patient selection. We did not compare the clinical outcome between patients
who did or did not have a second imaging study, which may have clarified this issue. Also, we excluded
patients with diffuse tumors since the diameter of the tumor could not be determined. However, these
patients are usually not eligible for surgical or interventional radiologic treatment and have much shorter
life expectancies. Further, only HCC patients with HBV or HCV were evaluated in this report. As such,
additional studies should include other disease entities such as alcohol-related and nonalcoholic fatty liver
disease-related HCC cases.

In summary, our findings suggest that TGR is influenced by AFP, platelet counts, and albumin levels. TGR
significantly influenced recurrence-free survival and response to surgical and locoregional treatments and
may be another potential imaging biomarker to predict clinical outcomes in patients with HCC.

DECLARATIONS
Acknowledgments
Jeffery Gornbein, Ph.D., assisted in the statistical analysis of the data; Lori Tong, RN, MSN, participated in
the care of these patients; Alex Rosinski, B.S., M.A., assisted in the collection of data in this study.