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Tong et al. Hepatoma Res 2019;5:36 Hepatoma Research
DOI: 10.20517/2394-5079.2019.005

Original Article Open Access

Tumor growth rates and recurrence-free survival in
chronic viral hepatitis patients with hepatocellular
carcinoma

Myron J. Tong , Dahlia A. Kaki , Claiborne T. Huynh , Steven S. Raman , David S. Lu 3
1
1,2
3
1
1 Liver Center, Huntington Medical Research Institutes, Pasadena, CA 91105, USA.
2 The Pfleger Liver Institute and the Division of Digestive Diseases, the David Geffen School of Medicine, University of California, Los
Angeles, CA 90095, USA.
3 Department of Radiological Sciences at the David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
Correspondence to: Dr. Myron J. Tong, Liver Center, Huntington Medical Research Institutes, 660 S. Fair Oaks Avenue, Pasadena, CA
91105, USA. E-mail: mjtsp@aol.com

How to cite this article: Tong MJ, Kaki DA, Huynh CT, Raman SS, Lu DS. Tumor growth rates and recurrence-free survival in chronic viral
hepatitis patients with hepatocellular carcinoma. Hepatoma Res 2019;5:36. http://dx.doi.org/10.20517/2394-5079.2019.005

Received: 16 Jul 2019 First Decision: 30 Aug 2019 Revised: 16 Aug 2019 Accepted: 18 Sep 2019 Published: 13 Oct 2019

Science Editor: Dalbir Sandhu Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
Aim: Survival in patients with hepatocellular carcinoma (HCC) is impacted by stage of liver disease, tumor
characteristics, and HCC surveillance in high-risk individuals. Factors associated with HCC tumor growth rate (TGR) and
its influence on recurrence-free survival after treatment was investigated.

Methods: TGR was calculated in 164 HCC patients with chronic viral hepatitis who had two consecutive magnetic
resonance imaging or computed tomography scans ≥ 30 days apart prior to treatment and who were followed
prospectively to determine the rates of recurrence-free survival.

Results: The median TGR in 164 patients was 17.8% per month (mean 33.3% per month). Regression tree analysis
indicated that the top three predictors of TGR were alpha-fetoprotein (AFP) levels (≥ 16.7 ng/mL), platelet counts (≥
3
140,000 mm ), and serum albumin level (< 3.55 g/dL). The regression tree identified patient groups with TGRs ranging
from 0.65% to 39.4% per month. At a median follow-up of 22 months, the overall recurrence-free survival was 53.8%.
The Cox model with backwards AIC search identified TGR (HR = 1.34, P = 0.029), age > 56 years (HR = 1.08, P =
0.072), hepatitis C virus (HR = 1.44, P = 0.091), macrovascular invasion (HR = 1.94, P = 0.092), and the most definitive
treatments (orthotopic liver transplantation, HR 0.14, P < 0.001; surgical resection, HR = 0.54, P = 0.072; radiofrequency
ablation, HR = 0.58, P = 0.060) as independent predictors of recurrence-free survival. For all treatment modalities, slow

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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