Is inconsistency of α-fetoprotein level a good prognosticator for hepatocellular carcinoma recurrence?

Chung-Bao Hsieh, Teng-Wei Chen, Chi-Ming Chu, Heng-Cheng Chu, Cheng-Ping Yu, Kuo-Piao Chung

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

AIM: To identify the clinical outcomes of hepatocellular carcinoma (HCC) patients with inconsistent α-fetoprotein (AFP) levels which were initially high and then low at recurrence. METHODS: We retrospectively included 178 patients who underwent liver resection with high preoperative AFP levels (≥ 200 ng/dL). Sixty-nine HCC patients had recurrence during follow-up and were grouped by their AFP levels at recurrence: group I, AFP ≤ 20 ng/dL (n = 16); group II, AFP 20-200 ng/dL (n = 24); and group III, AFP ≥ 200 ng/dL (n = 29). Their preoperative clinical characteristics, accumulated recurrence rate, and recurrence-to-death survival rate were compared. Three patients, one in each group, underwent liver resection twice for primary and recurrent HCC. AFP immunohistochemistry of primary and recurrent HCC specimens were examined. RESULTS: In this study, 23% of patients demonstrated normal AFP levels at HCC recurrence. The AFP levels in these patients were initially high. There were no significant differences in clinical characteristics between the three groups except for the mean recurrence interval (21.8 ± 14.6, 12.3 ± 7.7, 8.3 ± 6.6 mo, respectively, P <0.001) and survival time (40.2 ± 19.9, 36.1 ± 22.4, 21.9 ± 22.0 mo, respectively, P = 0.013). Tumor size > 5 cm, total bilirubin > 1.2 mg/dL, vessel invasion, Child classification B, group III, and recurrence interval <12 mo, were risk factors for survival rate. Cox regression analysis was performed and vessel invasion, group III, and recurrence interval were independent risk factors. The recurrence interval was significant longer in group I (P <0.001). The recurrence-to-death survival rate was significantly better in group II (P = 0.016). AFP staining was strong in the primary HCC specimens and was reduced at recurrence in group I specimens. CONCLUSION: Patients in group I with inconsistent AFP levels had a longer recurrence interval and worse recurrence-to-death survival rate than those in group II. This clinical presentation may be caused by a delay in the detection of HCC recurrence. © 2010 Baishideng.
Original languageEnglish
Pages (from-to)3049-3055
Number of pages7
JournalWorld Journal of Gastroenterology
Volume16
Issue number24
DOIs
Publication statusPublished - 2010
Externally publishedYes

Fingerprint

Fetal Proteins
Hepatocellular Carcinoma
Recurrence
Survival Rate
Mortality
Liver

Keywords

  • Hepatocellular carcinoma
  • Inconsistent a-fetoprotein
  • Outcome
  • Recurrence
  • alpha fetoprotein
  • bilirubin
  • adult
  • article
  • cancer recurrence
  • cancer survival
  • controlled study
  • female
  • human
  • immunohistochemistry
  • liver cell carcinoma
  • liver resection
  • major clinical study
  • male
  • prognosis
  • recurrence risk
  • tumor volume
  • aged
  • blood
  • Carcinoma, Hepatocellular
  • Liver Neoplasms
  • metabolism
  • middle aged
  • pathology
  • retrospective study
  • survival rate
  • tumor recurrence
  • Aged
  • alpha-Fetoproteins
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Prognosis
  • Retrospective Studies
  • Survival Rate

Cite this

Is inconsistency of α-fetoprotein level a good prognosticator for hepatocellular carcinoma recurrence? / Hsieh, Chung-Bao; Chen, Teng-Wei; Chu, Chi-Ming; Chu, Heng-Cheng; Yu, Cheng-Ping; Chung, Kuo-Piao.

In: World Journal of Gastroenterology, Vol. 16, No. 24, 2010, p. 3049-3055.

Research output: Contribution to journalArticle

Hsieh, Chung-Bao ; Chen, Teng-Wei ; Chu, Chi-Ming ; Chu, Heng-Cheng ; Yu, Cheng-Ping ; Chung, Kuo-Piao. / Is inconsistency of α-fetoprotein level a good prognosticator for hepatocellular carcinoma recurrence?. In: World Journal of Gastroenterology. 2010 ; Vol. 16, No. 24. pp. 3049-3055.
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title = "Is inconsistency of α-fetoprotein level a good prognosticator for hepatocellular carcinoma recurrence?",
abstract = "AIM: To identify the clinical outcomes of hepatocellular carcinoma (HCC) patients with inconsistent α-fetoprotein (AFP) levels which were initially high and then low at recurrence. METHODS: We retrospectively included 178 patients who underwent liver resection with high preoperative AFP levels (≥ 200 ng/dL). Sixty-nine HCC patients had recurrence during follow-up and were grouped by their AFP levels at recurrence: group I, AFP ≤ 20 ng/dL (n = 16); group II, AFP 20-200 ng/dL (n = 24); and group III, AFP ≥ 200 ng/dL (n = 29). Their preoperative clinical characteristics, accumulated recurrence rate, and recurrence-to-death survival rate were compared. Three patients, one in each group, underwent liver resection twice for primary and recurrent HCC. AFP immunohistochemistry of primary and recurrent HCC specimens were examined. RESULTS: In this study, 23{\%} of patients demonstrated normal AFP levels at HCC recurrence. The AFP levels in these patients were initially high. There were no significant differences in clinical characteristics between the three groups except for the mean recurrence interval (21.8 ± 14.6, 12.3 ± 7.7, 8.3 ± 6.6 mo, respectively, P <0.001) and survival time (40.2 ± 19.9, 36.1 ± 22.4, 21.9 ± 22.0 mo, respectively, P = 0.013). Tumor size > 5 cm, total bilirubin > 1.2 mg/dL, vessel invasion, Child classification B, group III, and recurrence interval <12 mo, were risk factors for survival rate. Cox regression analysis was performed and vessel invasion, group III, and recurrence interval were independent risk factors. The recurrence interval was significant longer in group I (P <0.001). The recurrence-to-death survival rate was significantly better in group II (P = 0.016). AFP staining was strong in the primary HCC specimens and was reduced at recurrence in group I specimens. CONCLUSION: Patients in group I with inconsistent AFP levels had a longer recurrence interval and worse recurrence-to-death survival rate than those in group II. This clinical presentation may be caused by a delay in the detection of HCC recurrence. {\circledC} 2010 Baishideng.",
keywords = "Hepatocellular carcinoma, Inconsistent a-fetoprotein, Outcome, Recurrence, alpha fetoprotein, bilirubin, adult, article, cancer recurrence, cancer survival, controlled study, female, human, immunohistochemistry, liver cell carcinoma, liver resection, major clinical study, male, prognosis, recurrence risk, tumor volume, aged, blood, Carcinoma, Hepatocellular, Liver Neoplasms, metabolism, middle aged, pathology, retrospective study, survival rate, tumor recurrence, Aged, alpha-Fetoproteins, Female, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Prognosis, Retrospective Studies, Survival Rate",
author = "Chung-Bao Hsieh and Teng-Wei Chen and Chi-Ming Chu and Heng-Cheng Chu and Cheng-Ping Yu and Kuo-Piao Chung",
note = "被引用次數:8 Export Date: 22 March 2016 CODEN: WJGAF 通訊地址: Chung, K.-P.; Graduate Institute of Health Care Organization Administration, National Taiwan University, 635, No. 17, Suchow Rd, Taipei 100, Taiwan; 電子郵件: kpchung@ntu.edu.tw 化學物質/CAS: bilirubin, 18422-02-1, 635-65-4; alpha-Fetoproteins; alpha-Fetoproteins 參考文獻: Chen, D.S., Sung, J.L., Serum alphafetoprotein in hepatocellular carcinoma (1977) Cancer, 40, pp. 779-783; Peng, S.Y., Lai, P.L., Chu, J.S., Lee, P.H., Tsung, P.T., Chen, D.S., Hsu, H.C., Expression and hypomethylation of alpha-fetoprotein gene in unicentric and multicentric human hepatocellular carcinomas (1993) Hepatology, 17, pp. 35-41; Kudo, M., Okanoue, T., Management of hepatocellular carcinoma in Japan: Consensus-based clinical practice manual proposed by the Japan Society of Hepatology (2007) Oncology, 72 (SUPPL 1), pp. 2-15; Bruix, J., Sherman, M., Management of hepatocellular carcinoma (2005) Hepatology, 42, pp. 1208-1236; Peng, S.Y., Chen, W.J., Lai, P.L., Jeng, Y.M., Sheu, J.C., Hsu, H.C., High alpha-fetoprotein level correlates with high stage, early recurrence and poor prognosis of hepatocellular carcinoma: Significance of hepatitis virus infection, age, p53 and betacatenin mutations (2004) Int J Cancer, 112, pp. 44-50; Tangkijvanich, P., Anukulkarnkusol, N., Suwangool, P., Lertmaharit, S., Hanvivatvong, O., Kullavanijaya, P., Poovorawan, Y., Clinical characteristics and prognosis of hepatocellular carcinoma: Analysis based on serum alpha-fetoprotein levels (2000) J Clin Gastroenterol, 31, pp. 302-308; Soresi, M., Magliarisi, C., Campagna, P., Leto, G., Bonfissuto, G., Riili, A., Carroccio, A., Montalto, G., Usefulness of alpha-fetoprotein in the diagnosis of hepatocellular carcinoma (2003) Anticancer Res, 23, pp. 1747-1753; Farinati, F., Marino, D., De Giorgio, M., Baldan, A., Cantarini, M., Cursaro, C., Rapaccini, G., Trevisani, F., Diagnostic and prognostic role of alpha-fetoprotein in hepatocellular carcinoma: Both or neither? (2006) Am J Gastroenterol, 101, pp. 524-532; Poon, R.T., Fan, S.T., Lo, C.M., Liu, C.L., Wong, J., Intrahepatic re- currence after curative resection of hepatocellular carcinoma: Long-term results of treatment and prognostic factors (1999) Ann Surg, 229, pp. 216-222; Choi, G.H., Kim, D.H., Kang, C.M., Kim, K.S., Choi, J.S., Lee, W.J., Kim, B.R., Prognostic factors and optimal treatment strategy for intrahepatic nodular recurrence after curative resection of hepatocellular carcinoma (2008) Ann Surg Oncol, 15, pp. 618-629; Choi, D., Lim, H.K., Rhim, H., Kim, Y.S., Yoo, B.C., Paik, S.W., Joh, J.W., Park, C.K., Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: Longterm results and prognostic factors (2007) Ann Surg Oncol, 14, pp. 2319-2329; Zhou, L., Liu, J., Luo, F., Serum tumor markers for detection of hepatocellular carcinoma (2006) World J Gastroenterol, 12, pp. 1175-1181; Chen, J.G., Parkin, D.M., Chen, Q.G., Lu, J.H., Shen, Q.J., Zhang, B.C., Zhu, Y.R., Screening for liver cancer: Results of a randomised controlled trial in Qidong, China (2003) J Med Screen, 10, pp. 204-209; Wong, L.L., Limm, W.M., Severino, R., Wong, L.M., Improved survival with screening for hepatocellular carcinoma (2000) Liver Transpl, 6, pp. 320-325; NCCN Clinical Practice Guidelines in Oncology Hepatobiliary cancers (Version 1, 2009), , http://www.nccn.org/professionals/physician_gls/PDF/hepatobiliary.pdf, Available from: URL:; Chen, Y.J., Yeh, S.H., Chen, J.T., Wu, C.C., Hsu, M.T., Tsai, S.F., Chen, P.J., Lin, C.H., Chromosomal changes and clonality relationship between primary and recurrent hepatocellular carcinoma (2000) Gastroenterology, 119, pp. 431-440; Chen, P.J., Chen, D.S., Lai, M.Y., Chang, M.H., Huang, G.T., Yang, P.M., Sheu, J.C., Sung, J.L., Clonal origin of recurrent hepatocellular carcinomas (1989) Gastroenterology, 96, pp. 527-529; Ding, S.F., Jalleh, R.P., Wood, C.B., Bowles, L., Delhanty, J.D., Dooley, J., Habib, N.A., Different DNA changes in primary and recurrent hepatocellular carcinoma (1992) Gut, 33, pp. 1433-1435; Okusaka, T., Okada, S., Nose, H., Ishii, H., Nakasuka, H., Nakayama, H., Nagahama, H., Hirohashi, S., The prognosis of patients with hepatocellular carcinoma of multicentric origin (1996) Hepatogastroenterology, 43, pp. 919-925; Furihata, T., Sawada, T., Kita, J., Iso, Y., Kato, M., Rokkaku, K., Shimoda, M., Kubota, K., Serum alpha-fetoprotein level per tumor volume reflects prognosis in patients with hepatocellular carcinoma after curative hepatectomy (2008) Hepatogastroenterology, 55, pp. 1705-1709; Shirabe, K., Takenaka, K., Gion, T., Shimada, M., Fujiwara, Y., Sugimachi, K., Significance of alpha-fetoprotein levels for detection of early recurrence of hepatocellular carcinoma after hepatic resection (1997) J Surg Oncol, 64, pp. 143-146",
year = "2010",
doi = "10.3748/wjg.v16.i24.3049",
language = "English",
volume = "16",
pages = "3049--3055",
journal = "World Journal of Gastroenterology",
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}

TY - JOUR

T1 - Is inconsistency of α-fetoprotein level a good prognosticator for hepatocellular carcinoma recurrence?

AU - Hsieh, Chung-Bao

AU - Chen, Teng-Wei

AU - Chu, Chi-Ming

AU - Chu, Heng-Cheng

AU - Yu, Cheng-Ping

AU - Chung, Kuo-Piao

N1 - 被引用次數:8 Export Date: 22 March 2016 CODEN: WJGAF 通訊地址: Chung, K.-P.; Graduate Institute of Health Care Organization Administration, National Taiwan University, 635, No. 17, Suchow Rd, Taipei 100, Taiwan; 電子郵件: kpchung@ntu.edu.tw 化學物質/CAS: bilirubin, 18422-02-1, 635-65-4; alpha-Fetoproteins; alpha-Fetoproteins 參考文獻: Chen, D.S., Sung, J.L., Serum alphafetoprotein in hepatocellular carcinoma (1977) Cancer, 40, pp. 779-783; Peng, S.Y., Lai, P.L., Chu, J.S., Lee, P.H., Tsung, P.T., Chen, D.S., Hsu, H.C., Expression and hypomethylation of alpha-fetoprotein gene in unicentric and multicentric human hepatocellular carcinomas (1993) Hepatology, 17, pp. 35-41; Kudo, M., Okanoue, T., Management of hepatocellular carcinoma in Japan: Consensus-based clinical practice manual proposed by the Japan Society of Hepatology (2007) Oncology, 72 (SUPPL 1), pp. 2-15; Bruix, J., Sherman, M., Management of hepatocellular carcinoma (2005) Hepatology, 42, pp. 1208-1236; Peng, S.Y., Chen, W.J., Lai, P.L., Jeng, Y.M., Sheu, J.C., Hsu, H.C., High alpha-fetoprotein level correlates with high stage, early recurrence and poor prognosis of hepatocellular carcinoma: Significance of hepatitis virus infection, age, p53 and betacatenin mutations (2004) Int J Cancer, 112, pp. 44-50; Tangkijvanich, P., Anukulkarnkusol, N., Suwangool, P., Lertmaharit, S., Hanvivatvong, O., Kullavanijaya, P., Poovorawan, Y., Clinical characteristics and prognosis of hepatocellular carcinoma: Analysis based on serum alpha-fetoprotein levels (2000) J Clin Gastroenterol, 31, pp. 302-308; Soresi, M., Magliarisi, C., Campagna, P., Leto, G., Bonfissuto, G., Riili, A., Carroccio, A., Montalto, G., Usefulness of alpha-fetoprotein in the diagnosis of hepatocellular carcinoma (2003) Anticancer Res, 23, pp. 1747-1753; Farinati, F., Marino, D., De Giorgio, M., Baldan, A., Cantarini, M., Cursaro, C., Rapaccini, G., Trevisani, F., Diagnostic and prognostic role of alpha-fetoprotein in hepatocellular carcinoma: Both or neither? (2006) Am J Gastroenterol, 101, pp. 524-532; Poon, R.T., Fan, S.T., Lo, C.M., Liu, C.L., Wong, J., Intrahepatic re- currence after curative resection of hepatocellular carcinoma: Long-term results of treatment and prognostic factors (1999) Ann Surg, 229, pp. 216-222; Choi, G.H., Kim, D.H., Kang, C.M., Kim, K.S., Choi, J.S., Lee, W.J., Kim, B.R., Prognostic factors and optimal treatment strategy for intrahepatic nodular recurrence after curative resection of hepatocellular carcinoma (2008) Ann Surg Oncol, 15, pp. 618-629; Choi, D., Lim, H.K., Rhim, H., Kim, Y.S., Yoo, B.C., Paik, S.W., Joh, J.W., Park, C.K., Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: Longterm results and prognostic factors (2007) Ann Surg Oncol, 14, pp. 2319-2329; Zhou, L., Liu, J., Luo, F., Serum tumor markers for detection of hepatocellular carcinoma (2006) World J Gastroenterol, 12, pp. 1175-1181; Chen, J.G., Parkin, D.M., Chen, Q.G., Lu, J.H., Shen, Q.J., Zhang, B.C., Zhu, Y.R., Screening for liver cancer: Results of a randomised controlled trial in Qidong, China (2003) J Med Screen, 10, pp. 204-209; Wong, L.L., Limm, W.M., Severino, R., Wong, L.M., Improved survival with screening for hepatocellular carcinoma (2000) Liver Transpl, 6, pp. 320-325; NCCN Clinical Practice Guidelines in Oncology Hepatobiliary cancers (Version 1, 2009), , http://www.nccn.org/professionals/physician_gls/PDF/hepatobiliary.pdf, Available from: URL:; Chen, Y.J., Yeh, S.H., Chen, J.T., Wu, C.C., Hsu, M.T., Tsai, S.F., Chen, P.J., Lin, C.H., Chromosomal changes and clonality relationship between primary and recurrent hepatocellular carcinoma (2000) Gastroenterology, 119, pp. 431-440; Chen, P.J., Chen, D.S., Lai, M.Y., Chang, M.H., Huang, G.T., Yang, P.M., Sheu, J.C., Sung, J.L., Clonal origin of recurrent hepatocellular carcinomas (1989) Gastroenterology, 96, pp. 527-529; Ding, S.F., Jalleh, R.P., Wood, C.B., Bowles, L., Delhanty, J.D., Dooley, J., Habib, N.A., Different DNA changes in primary and recurrent hepatocellular carcinoma (1992) Gut, 33, pp. 1433-1435; Okusaka, T., Okada, S., Nose, H., Ishii, H., Nakasuka, H., Nakayama, H., Nagahama, H., Hirohashi, S., The prognosis of patients with hepatocellular carcinoma of multicentric origin (1996) Hepatogastroenterology, 43, pp. 919-925; Furihata, T., Sawada, T., Kita, J., Iso, Y., Kato, M., Rokkaku, K., Shimoda, M., Kubota, K., Serum alpha-fetoprotein level per tumor volume reflects prognosis in patients with hepatocellular carcinoma after curative hepatectomy (2008) Hepatogastroenterology, 55, pp. 1705-1709; Shirabe, K., Takenaka, K., Gion, T., Shimada, M., Fujiwara, Y., Sugimachi, K., Significance of alpha-fetoprotein levels for detection of early recurrence of hepatocellular carcinoma after hepatic resection (1997) J Surg Oncol, 64, pp. 143-146

PY - 2010

Y1 - 2010

N2 - AIM: To identify the clinical outcomes of hepatocellular carcinoma (HCC) patients with inconsistent α-fetoprotein (AFP) levels which were initially high and then low at recurrence. METHODS: We retrospectively included 178 patients who underwent liver resection with high preoperative AFP levels (≥ 200 ng/dL). Sixty-nine HCC patients had recurrence during follow-up and were grouped by their AFP levels at recurrence: group I, AFP ≤ 20 ng/dL (n = 16); group II, AFP 20-200 ng/dL (n = 24); and group III, AFP ≥ 200 ng/dL (n = 29). Their preoperative clinical characteristics, accumulated recurrence rate, and recurrence-to-death survival rate were compared. Three patients, one in each group, underwent liver resection twice for primary and recurrent HCC. AFP immunohistochemistry of primary and recurrent HCC specimens were examined. RESULTS: In this study, 23% of patients demonstrated normal AFP levels at HCC recurrence. The AFP levels in these patients were initially high. There were no significant differences in clinical characteristics between the three groups except for the mean recurrence interval (21.8 ± 14.6, 12.3 ± 7.7, 8.3 ± 6.6 mo, respectively, P <0.001) and survival time (40.2 ± 19.9, 36.1 ± 22.4, 21.9 ± 22.0 mo, respectively, P = 0.013). Tumor size > 5 cm, total bilirubin > 1.2 mg/dL, vessel invasion, Child classification B, group III, and recurrence interval <12 mo, were risk factors for survival rate. Cox regression analysis was performed and vessel invasion, group III, and recurrence interval were independent risk factors. The recurrence interval was significant longer in group I (P <0.001). The recurrence-to-death survival rate was significantly better in group II (P = 0.016). AFP staining was strong in the primary HCC specimens and was reduced at recurrence in group I specimens. CONCLUSION: Patients in group I with inconsistent AFP levels had a longer recurrence interval and worse recurrence-to-death survival rate than those in group II. This clinical presentation may be caused by a delay in the detection of HCC recurrence. © 2010 Baishideng.

AB - AIM: To identify the clinical outcomes of hepatocellular carcinoma (HCC) patients with inconsistent α-fetoprotein (AFP) levels which were initially high and then low at recurrence. METHODS: We retrospectively included 178 patients who underwent liver resection with high preoperative AFP levels (≥ 200 ng/dL). Sixty-nine HCC patients had recurrence during follow-up and were grouped by their AFP levels at recurrence: group I, AFP ≤ 20 ng/dL (n = 16); group II, AFP 20-200 ng/dL (n = 24); and group III, AFP ≥ 200 ng/dL (n = 29). Their preoperative clinical characteristics, accumulated recurrence rate, and recurrence-to-death survival rate were compared. Three patients, one in each group, underwent liver resection twice for primary and recurrent HCC. AFP immunohistochemistry of primary and recurrent HCC specimens were examined. RESULTS: In this study, 23% of patients demonstrated normal AFP levels at HCC recurrence. The AFP levels in these patients were initially high. There were no significant differences in clinical characteristics between the three groups except for the mean recurrence interval (21.8 ± 14.6, 12.3 ± 7.7, 8.3 ± 6.6 mo, respectively, P <0.001) and survival time (40.2 ± 19.9, 36.1 ± 22.4, 21.9 ± 22.0 mo, respectively, P = 0.013). Tumor size > 5 cm, total bilirubin > 1.2 mg/dL, vessel invasion, Child classification B, group III, and recurrence interval <12 mo, were risk factors for survival rate. Cox regression analysis was performed and vessel invasion, group III, and recurrence interval were independent risk factors. The recurrence interval was significant longer in group I (P <0.001). The recurrence-to-death survival rate was significantly better in group II (P = 0.016). AFP staining was strong in the primary HCC specimens and was reduced at recurrence in group I specimens. CONCLUSION: Patients in group I with inconsistent AFP levels had a longer recurrence interval and worse recurrence-to-death survival rate than those in group II. This clinical presentation may be caused by a delay in the detection of HCC recurrence. © 2010 Baishideng.

KW - Hepatocellular carcinoma

KW - Inconsistent a-fetoprotein

KW - Outcome

KW - Recurrence

KW - alpha fetoprotein

KW - bilirubin

KW - adult

KW - article

KW - cancer recurrence

KW - cancer survival

KW - controlled study

KW - female

KW - human

KW - immunohistochemistry

KW - liver cell carcinoma

KW - liver resection

KW - major clinical study

KW - male

KW - prognosis

KW - recurrence risk

KW - tumor volume

KW - aged

KW - blood

KW - Carcinoma, Hepatocellular

KW - Liver Neoplasms

KW - metabolism

KW - middle aged

KW - pathology

KW - retrospective study

KW - survival rate

KW - tumor recurrence

KW - Aged

KW - alpha-Fetoproteins

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasm Recurrence, Local

KW - Prognosis

KW - Retrospective Studies

KW - Survival Rate

U2 - 10.3748/wjg.v16.i24.3049

DO - 10.3748/wjg.v16.i24.3049

M3 - Article

VL - 16

SP - 3049

EP - 3055

JO - World Journal of Gastroenterology

JF - World Journal of Gastroenterology

SN - 1007-9327

IS - 24

ER -