Prognostic value of the modified TNM (Izumi) classification of hepatocellular carcinoma in 53 cirrhotic patients undergoing resection

Background/Aims: Few studies have assessed the significance of prognostic f actors in cirrhotic patients undergoing resection for hepatocellular carcin oma. Methodology: Overall survival and disease-free survival were evaluated in 5 3 cirrhotic patients undergoing hepatic resection for supervening hepatocel lular carcinoma. The value of the UICC TNM classification, and the Izumi mo dified staging system on prognosis were analyzed. Results: In multivariate analysis lack of micro/macrovascular invasion were predictive for longterm outcome. The difference between stages 1 and 2 or stage 3 and 4A using the UICC TNM classification was not significant; with respect to survival or disease-free survival. UICC TNM classification was m odified as follows; stage 1, solitary tumor without vascular invasion; stag e 2, solitary or multiple tumor(s) involving adjacent vessel branch; stage 3, tumor(s) involving major vessel branch or with regional lymph node metas tases; stage 4, tumor(s) with distant metastases. TNM (modified in accordan ce with Izumi) showed a significant difference between each stage with resp ect to survival and disease-free survival. Conclusions: A uniform tumor classification of hepatocellular carcinoma is advocated. Our results show that the UICC TNM classification for hepatocell ular carcinoma is inadequate and may even on occasion lead to unnecessary r esection. The modified staging system of Izumi is superior in determining o utcome for cirrhotic patients with supervening hepatocellular carcinoma und ergoing resection.