Background/aims: Since chronic liver disease is generally considered a pre-malignant condition, recurrence in the residual liver after hepatic resection for hepatocellular carcinoma may be related to the malignant potential of the underlying liver disease.
Methodology: We studied non-cancerous regions of hepatocellular carcinomas that were 3 cm or smaller in diameter from 170 patients who underwent curative hepatic resection. The presence of clusters of hyperplastic small cells, which we called hyperplastic foci, was investigated microscopically. The nuclei of the cells in hyperplastic foci were normal, but the nuclear/cytoplasmic ratio was high, cellularity was increased compared with neighboring regions, and the hepatic trabeculae were somewhat thick. We also calculated the labeling index in hyperplastic foci areas by proliferating cell nuclear antigen and compared this to that of hepatocytes without cellular atypia.
Results: In 59 of 170 patients (35%), hyperplastic foci were found. The labeling index in hyperplastic foci was significantly higher than in control regions (p = 0.0016). As of December 1995, 113 patients (63%) were found to have a recurrence. When hyperplastic foci were found, the tumor-free survival rate was significantly lower (p = 0.0443).
Conclusions: Hyperplastic foci represent an important predictor of recurrence after hepatic resection for a small hepatocellular carcinoma.