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Published in: Annals of Surgical Oncology 3/2007

01-03-2007

Clinical Characteristics and Surgical Outcome in Hepatocellular Carcinoma without Hepatitis B Virus Surface Antigen or Hepatitis C Virus Antibody

Authors: Kuniya Tanaka, MD, PhD, Hiroshi Shimada, MD, PhD, Kenichi Matsuo, MD, Yasuhiko Nagano, MD, Itaru Endo, MD, PhD, Shinji Togo, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2007

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Abstract

Objective

We investigated clinical characteristics and surgical outcome of hepatocellular carcinoma in association with hepatitis viral status.

Summary Background Data

No consensus exists concerning differences in surgical outcome in patients with hepatocellular carcinoma according to viral hepatitis status, especially those negative for hepatitis B virus surface antigen and antibody to hepatitis C virus.

Methods

Clinicopathologic data were available for 39 hepatectomy patients with hepatocellular carcinoma who were negative for hepatitis B virus surface antigen and hepatitis C virus antibody. Clinical characteristics and surgical outcome were analyzed retrospectively and compared to those patients with positive hepatitis viral markers.

Results

Patients negative for viral hepatitis markers were more likely to have large, advanced-stages tumors with relatively well-preserved liver function and had a lower incidence of intrahepatic recurrences (P = 0.009). The intrahepatic recurrence rate reached a plateau at approximately 3 years after resection in patients with negative viral markers, while it continued to increase steadily in patients positive for viral hepatitis markers. By multivariable analysis, the absence of viral hepatitis markers predicted a decreased rate of intrahepatic recurrence (relative risk, 0.222; P = 0.001).

Conclusions

Adequate surgical resection in hepatocellular carcinoma patients negative for viral markers offers a good survival benefit, regardless of the etiology of the hepatocellular carcinoma.
Literature
1.
go back to reference Miyagawa S, Kawasaki S, Makuuchi M. Comparison of the characteristics of hepatocellular carcinoma between hepatitis B and C viral infection: tumor multicentricity in cirrhotic liver with hepatitis C. Hepatology 1996;24: 307–310PubMedCrossRef Miyagawa S, Kawasaki S, Makuuchi M. Comparison of the characteristics of hepatocellular carcinoma between hepatitis B and C viral infection: tumor multicentricity in cirrhotic liver with hepatitis C. Hepatology 1996;24: 307–310PubMedCrossRef
2.
go back to reference Kiyosawa K, Sodeyama T, Tanaka E, et al. Interrelationship of blood transfusion, non-A, non-B hepatitis and hepatocellular carcinoma: analysis by detection of antibody to hepatitis C virus. Hepatology 1990;12: 671–675PubMedCrossRef Kiyosawa K, Sodeyama T, Tanaka E, et al. Interrelationship of blood transfusion, non-A, non-B hepatitis and hepatocellular carcinoma: analysis by detection of antibody to hepatitis C virus. Hepatology 1990;12: 671–675PubMedCrossRef
3.
go back to reference Kubo S, Nishiguchi S, Hirohashi K, et al. High prevalence of infection with hepatitis B and C viruses in patients with hepatocellular carcinoma in Japan. Hepatogastroenterology 1999;46: 357–359PubMed Kubo S, Nishiguchi S, Hirohashi K, et al. High prevalence of infection with hepatitis B and C viruses in patients with hepatocellular carcinoma in Japan. Hepatogastroenterology 1999;46: 357–359PubMed
4.
go back to reference Shiratori Y. Different clinicopathological features of hepatitis B- and C-related hepatocellular carcinoma. J Gastroenterol Hepatol 1996;11: 942–943PubMed Shiratori Y. Different clinicopathological features of hepatitis B- and C-related hepatocellular carcinoma. J Gastroenterol Hepatol 1996;11: 942–943PubMed
5.
go back to reference Brechot C, Poucel C, Louise A, Rain B, Tiollaris P. Presence of integrated hepatitis B virus DNA sequences in cellular DNA of human hepatocellular carcinoma. Nature 1980;286: 533–535PubMedCrossRef Brechot C, Poucel C, Louise A, Rain B, Tiollaris P. Presence of integrated hepatitis B virus DNA sequences in cellular DNA of human hepatocellular carcinoma. Nature 1980;286: 533–535PubMedCrossRef
6.
go back to reference Bressac B, Galvin KM, Liang TJ, Isselbacher KJ, Wands JR, Ozturk M. Abnormal structure and expression of p53 gene in human hepatocellular carcinoma. Proc Natl Acad Sci USA 1990;87: 1973–1977PubMedCrossRef Bressac B, Galvin KM, Liang TJ, Isselbacher KJ, Wands JR, Ozturk M. Abnormal structure and expression of p53 gene in human hepatocellular carcinoma. Proc Natl Acad Sci USA 1990;87: 1973–1977PubMedCrossRef
7.
go back to reference Sherlock S. Viruses and hepatocellular carcinoma. Gut 1994;35: 828–832PubMed Sherlock S. Viruses and hepatocellular carcinoma. Gut 1994;35: 828–832PubMed
8.
go back to reference Tarao K, Ohkawa S, Shimizu A, et al. Significance of hepatocellular proliferation in the development of hepatocellular carcinoma from anti-hepatitis C virus-positive cirrhotic patients. Cancer 1994;73: 1149–1154PubMedCrossRef Tarao K, Ohkawa S, Shimizu A, et al. Significance of hepatocellular proliferation in the development of hepatocellular carcinoma from anti-hepatitis C virus-positive cirrhotic patients. Cancer 1994;73: 1149–1154PubMedCrossRef
9.
go back to reference Aihara T, Noguchi S, Sasaki Y, Nakano H, Imaoka S. Clonal analysis of regenerative nodules in hepatitis C virus-induced liver cirrhosis. Gastroenterology 1994;107: 1805–1811PubMed Aihara T, Noguchi S, Sasaki Y, Nakano H, Imaoka S. Clonal analysis of regenerative nodules in hepatitis C virus-induced liver cirrhosis. Gastroenterology 1994;107: 1805–1811PubMed
10.
go back to reference Moriya K, Fujie H, Shintani Y, et al. The core protein of hepatitis C virus induces hepatocellular carcinoma in transgenic mice. Nat Med 1998;4: 1065–1067PubMedCrossRef Moriya K, Fujie H, Shintani Y, et al. The core protein of hepatitis C virus induces hepatocellular carcinoma in transgenic mice. Nat Med 1998;4: 1065–1067PubMedCrossRef
11.
go back to reference Shiratori Y, Shiina S, Imamura M, et al. Characteristic difference of hepatocellular carcinoma between hepatitis B- and C- viral infection in Japan. Hepatology 1995;22: 1027–1033PubMed Shiratori Y, Shiina S, Imamura M, et al. Characteristic difference of hepatocellular carcinoma between hepatitis B- and C- viral infection in Japan. Hepatology 1995;22: 1027–1033PubMed
12.
go back to reference Ikeda K, Saitoh S, Koida I, et al. A multivariate analysis of risk factors for hepatocellular carcinogenesis: a prospective observation of 795 patients with viral and alcoholic cirrhosis. Hepatology 1993;18: 47–53PubMed Ikeda K, Saitoh S, Koida I, et al. A multivariate analysis of risk factors for hepatocellular carcinogenesis: a prospective observation of 795 patients with viral and alcoholic cirrhosis. Hepatology 1993;18: 47–53PubMed
13.
go back to reference Yu MC, Tong MJ, Govindarajan S, Henderson BE. Nonviral risk factors for hepatocellular carcinoma in a low-risk population, the non-Asians of Los Angeles County, California. J Natl Cancer Inst 1991;83: 1820–1826PubMedCrossRef Yu MC, Tong MJ, Govindarajan S, Henderson BE. Nonviral risk factors for hepatocellular carcinoma in a low-risk population, the non-Asians of Los Angeles County, California. J Natl Cancer Inst 1991;83: 1820–1826PubMedCrossRef
14.
go back to reference Yamanaka N, Tanaka T, Tanaka W, et al. Correlation of hepatitis virus serologic status with clinicopathologic features in patients undergoing hepatectomy for hepatocellular carcinoma. Cancer 1997;79: 1509–1515PubMedCrossRef Yamanaka N, Tanaka T, Tanaka W, et al. Correlation of hepatitis virus serologic status with clinicopathologic features in patients undergoing hepatectomy for hepatocellular carcinoma. Cancer 1997;79: 1509–1515PubMedCrossRef
15.
go back to reference Nagasue N, Ono T, Yamanoi A, Kohno H, El-Assal ON, Taniura H, Uchida M. Prognostic factors and survival after hepatic resection for hepatocellular carcinoma without cirrhosis. Br J Surg 2001;88: 515–522PubMedCrossRef Nagasue N, Ono T, Yamanoi A, Kohno H, El-Assal ON, Taniura H, Uchida M. Prognostic factors and survival after hepatic resection for hepatocellular carcinoma without cirrhosis. Br J Surg 2001;88: 515–522PubMedCrossRef
16.
go back to reference Roayaie S, Haim MB, Emre S, et al. Comparison of surgical outcomes for hepatocellular carcinoma in patients with hepatitis B versus hepatitis C: a western experience. Ann Surg Oncol 2000;7: 764–770PubMedCrossRef Roayaie S, Haim MB, Emre S, et al. Comparison of surgical outcomes for hepatocellular carcinoma in patients with hepatitis B versus hepatitis C: a western experience. Ann Surg Oncol 2000;7: 764–770PubMedCrossRef
17.
go back to reference Dohmen K, Shigematsu H, Irie K, Ishibashi H. Comparison of the clinical characteristics among hepatocellular carcinoma of hepatitis B, hepatitis C and non-B non-C patients. Hepatogastroenterology 2003;50: 2022–2027PubMed Dohmen K, Shigematsu H, Irie K, Ishibashi H. Comparison of the clinical characteristics among hepatocellular carcinoma of hepatitis B, hepatitis C and non-B non-C patients. Hepatogastroenterology 2003;50: 2022–2027PubMed
18.
go back to reference Chen MF, Jeng LB, Lee WC, Chen TC. Surgical results in patients with dual hepatitis B- and C-related hepatocellular carcinoma compared with hepatitis B- or C-related hepatocellular carcinoma. Surgery 1998;123: 554–559PubMedCrossRef Chen MF, Jeng LB, Lee WC, Chen TC. Surgical results in patients with dual hepatitis B- and C-related hepatocellular carcinoma compared with hepatitis B- or C-related hepatocellular carcinoma. Surgery 1998;123: 554–559PubMedCrossRef
19.
go back to reference Takeda S, Nagafuchi Y, Tashiro H, et al. Antihepatitis C virus status in hepatocellular carcinoma and the influence on clinicopathological findings and operative results. Br J Surg 1992;79: 1195–1198PubMedCrossRef Takeda S, Nagafuchi Y, Tashiro H, et al. Antihepatitis C virus status in hepatocellular carcinoma and the influence on clinicopathological findings and operative results. Br J Surg 1992;79: 1195–1198PubMedCrossRef
20.
go back to reference Yamanaka N, Okamoto E, Oriyama T, et al. A prediction scoring system to select the surgical treatment of liver cancer. Further refinement based on 10 years of use. Ann Surg 1994;219: 342–346PubMedCrossRef Yamanaka N, Okamoto E, Oriyama T, et al. A prediction scoring system to select the surgical treatment of liver cancer. Further refinement based on 10 years of use. Ann Surg 1994;219: 342–346PubMedCrossRef
21.
go back to reference The Brisbane 2000 Terminology of Liver Anatomy and Resection. Terminology Committee of the International Hepato-Pancreato-Biliary Association. HPB 2000;2: 333–339 The Brisbane 2000 Terminology of Liver Anatomy and Resection. Terminology Committee of the International Hepato-Pancreato-Biliary Association. HPB 2000;2: 333–339
22.
go back to reference The Cancer of the Liver Italian Program (CLIP) Investigators. A new prognostic system for hepatocellular carcinoma: A retrospective study of 435 patients. Hepatology 1998;28: 751–755CrossRef The Cancer of the Liver Italian Program (CLIP) Investigators. A new prognostic system for hepatocellular carcinoma: A retrospective study of 435 patients. Hepatology 1998;28: 751–755CrossRef
23.
go back to reference Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): Its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol 2003;38: 207–215PubMedCrossRef Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): Its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol 2003;38: 207–215PubMedCrossRef
24.
go back to reference Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60: 646–649PubMedCrossRef Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60: 646–649PubMedCrossRef
25.
go back to reference Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th ed. Chicago, USA: Springer; 2002. p. 131–144 Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th ed. Chicago, USA: Springer; 2002. p. 131–144
26.
go back to reference Ichida F, Tsuji T, Omata M, et al. New Inuyama classification for histological assessment of chronic hepatitis. Int Hepatol Commun 1996;6: 112–119CrossRef Ichida F, Tsuji T, Omata M, et al. New Inuyama classification for histological assessment of chronic hepatitis. Int Hepatol Commun 1996;6: 112–119CrossRef
27.
go back to reference Takano S, Yokosuka O, Imazeki F, Tagawa M, Omata M. Incidence of hepatocellular carcinoma in chronic hepatitis B, C: a prospective study of 251 patients. Hepatology 1995;21: 650–655PubMed Takano S, Yokosuka O, Imazeki F, Tagawa M, Omata M. Incidence of hepatocellular carcinoma in chronic hepatitis B, C: a prospective study of 251 patients. Hepatology 1995;21: 650–655PubMed
28.
go back to reference Shiratori Y, Shiina S, Zhang PY, et al. Does dual infection by hepatitis B and C viruses play an important role in the pathogenesis of hepatocellular carcinoma in Japan? Cancer 1997;80: 2060–2067PubMedCrossRef Shiratori Y, Shiina S, Zhang PY, et al. Does dual infection by hepatitis B and C viruses play an important role in the pathogenesis of hepatocellular carcinoma in Japan? Cancer 1997;80: 2060–2067PubMedCrossRef
29.
go back to reference Wakai T, Shirai Y, Yokoyama N, Nagakura S, Hatakeyama K. Hepatitis viral status affects the pattern of intrahepatic recurrence after resection for hepatocellular carcinoma. Eur J Surg Oncol 2003;29: 266–271PubMedCrossRef Wakai T, Shirai Y, Yokoyama N, Nagakura S, Hatakeyama K. Hepatitis viral status affects the pattern of intrahepatic recurrence after resection for hepatocellular carcinoma. Eur J Surg Oncol 2003;29: 266–271PubMedCrossRef
30.
go back to reference Poon RT, Fan ST, Ng IO, Lo CM, Liu CL, Wong J. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer 2000;89: 500–507PubMedCrossRef Poon RT, Fan ST, Ng IO, Lo CM, Liu CL, Wong J. Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer 2000;89: 500–507PubMedCrossRef
31.
go back to reference Takenaka K, Adachi E, Nishizaki T, Hiroshige K, Ikeda T, Tsuneyoshi M, Sugimachi K. Possible multicentric occurrence of hepatocellular carcinoma: a clinicopathological study. Hepatology 1994;19: 889–894PubMedCrossRef Takenaka K, Adachi E, Nishizaki T, Hiroshige K, Ikeda T, Tsuneyoshi M, Sugimachi K. Possible multicentric occurrence of hepatocellular carcinoma: a clinicopathological study. Hepatology 1994;19: 889–894PubMedCrossRef
32.
go back to reference Shimada M, Hamatsu T, Yamashita Y, et al. Characteristics of multicentric hepatocellular carcinomas: comparison with intrahepatic metastasis. World J Surg 2001;25: 991–995PubMedCrossRef Shimada M, Hamatsu T, Yamashita Y, et al. Characteristics of multicentric hepatocellular carcinomas: comparison with intrahepatic metastasis. World J Surg 2001;25: 991–995PubMedCrossRef
33.
go back to reference Nakano S, Haratake J, Okamoto K, Takeda S. Investigation of resected multinodular hepatocellular carcinoma: assessment of unicentric or multicentric genesis from histological and prognostic viewpoint. Am J Gastroenterol 1994;89: 189–193PubMed Nakano S, Haratake J, Okamoto K, Takeda S. Investigation of resected multinodular hepatocellular carcinoma: assessment of unicentric or multicentric genesis from histological and prognostic viewpoint. Am J Gastroenterol 1994;89: 189–193PubMed
34.
go back to reference Koike Y, Shiratori Y, Sato S, et al. Risk factors for recurring hepatocellular carcinoma differ according to infected hepatitis virus- an analysis of 236 consecutive patients with a single lesion. Hepatology 2000;32: 1216–1223PubMedCrossRef Koike Y, Shiratori Y, Sato S, et al. Risk factors for recurring hepatocellular carcinoma differ according to infected hepatitis virus- an analysis of 236 consecutive patients with a single lesion. Hepatology 2000;32: 1216–1223PubMedCrossRef
35.
go back to reference Portolani N, Coniglio A, Ghidoni S, Giovanelli M, Benetti A, Tiberio GA, Giulini SM. Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg 2006;243: 229–235PubMedCrossRef Portolani N, Coniglio A, Ghidoni S, Giovanelli M, Benetti A, Tiberio GA, Giulini SM. Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg 2006;243: 229–235PubMedCrossRef
36.
go back to reference Ikeda K, Saitoh S, Tsubota A, et al. Risk factors for tumor recurrence and prognosis after curative resection of hepatocellular carcinoma. Cancer 1993;71: 19–25PubMedCrossRef Ikeda K, Saitoh S, Tsubota A, et al. Risk factors for tumor recurrence and prognosis after curative resection of hepatocellular carcinoma. Cancer 1993;71: 19–25PubMedCrossRef
37.
go back to reference Belghiti J, Panis Y, Farges O, Benhamou JP, Fekete F. Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg 1991;214: 114–117PubMedCrossRef Belghiti J, Panis Y, Farges O, Benhamou JP, Fekete F. Intrahepatic recurrence after resection of hepatocellular carcinoma complicating cirrhosis. Ann Surg 1991;214: 114–117PubMedCrossRef
38.
go back to reference Pompili M, Rapaccini GL, de Luca F, et al. Risk factors for intrahepatic recurrence of hepatocellular carcinoma in cirrhotic patients treated by percutaneous ethanol injection. Cancer 1997;79: 1501–1508PubMedCrossRef Pompili M, Rapaccini GL, de Luca F, et al. Risk factors for intrahepatic recurrence of hepatocellular carcinoma in cirrhotic patients treated by percutaneous ethanol injection. Cancer 1997;79: 1501–1508PubMedCrossRef
39.
go back to reference Lise M, Bacchetti S, Da Pian P, Nitti D, Pilati PL, Pigato P. Prognostic factors affecting long-term outcome after liver resection for hepatocellular carcinoma: results in a series of 100 Italian patients. Cancer 1998;82: 1028–1036PubMedCrossRef Lise M, Bacchetti S, Da Pian P, Nitti D, Pilati PL, Pigato P. Prognostic factors affecting long-term outcome after liver resection for hepatocellular carcinoma: results in a series of 100 Italian patients. Cancer 1998;82: 1028–1036PubMedCrossRef
40.
go back to reference Yamamoto J, Kosuge T, Takayama T, et al. Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 1994;115: 303–309PubMed Yamamoto J, Kosuge T, Takayama T, et al. Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 1994;115: 303–309PubMed
41.
go back to reference Noguchi K, Nakashima O, Nakashima Y, Shiota K, Nawata H, Kojiro M. Clinicopathologic study on hepatocellular carcinoma negative for hepatitis B surface antigen and antibody to hepatitis C virus. Int J Mol Med 2000;6: 661–665PubMed Noguchi K, Nakashima O, Nakashima Y, Shiota K, Nawata H, Kojiro M. Clinicopathologic study on hepatocellular carcinoma negative for hepatitis B surface antigen and antibody to hepatitis C virus. Int J Mol Med 2000;6: 661–665PubMed
42.
go back to reference Kuhns M, McNamara A, Mason A, Campbell C, Perrillo R. Serum and liver hepatitis B virus DNA in chronic hepatitis B after sustained loss of surface antigen. Gastroenterology 1992;103: 1649–56PubMed Kuhns M, McNamara A, Mason A, Campbell C, Perrillo R. Serum and liver hepatitis B virus DNA in chronic hepatitis B after sustained loss of surface antigen. Gastroenterology 1992;103: 1649–56PubMed
43.
go back to reference Fong TL, Di Bisceglie AM, Gerber MA, Waggoner JG, Hoofnagle JH. Persistence of hepatitis B virus DNA in the liver after loss of HBsAg in chronic hepatitis B. Hepatology 1993;18: 1313–8PubMed Fong TL, Di Bisceglie AM, Gerber MA, Waggoner JG, Hoofnagle JH. Persistence of hepatitis B virus DNA in the liver after loss of HBsAg in chronic hepatitis B. Hepatology 1993;18: 1313–8PubMed
44.
go back to reference Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 2004;127: S35–S50PubMedCrossRef Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 2004;127: S35–S50PubMedCrossRef
45.
go back to reference Marrero JA, Fontana RJ, Su GL, Conjeevaram HS, Emick DM, Lok AS. NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States. Hepatology 2002;36: 1349–1354PubMedCrossRef Marrero JA, Fontana RJ, Su GL, Conjeevaram HS, Emick DM, Lok AS. NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States. Hepatology 2002;36: 1349–1354PubMedCrossRef
46.
go back to reference Clark JM. The epidemiology of nonalcoholic fatty liver disease in adults. J Clin Gastroenterol 2006;40: S5–S10PubMed Clark JM. The epidemiology of nonalcoholic fatty liver disease in adults. J Clin Gastroenterol 2006;40: S5–S10PubMed
48.
go back to reference Paterlini P, Gerken G, Nakajima E, et al. Polymerase chain reaction to detect hepatitis B virus DNA and RNA sequences in primary liver cancers from patients negative for hepatitis B surface antigen. N Engl J Med 1990;323: 80–85PubMedCrossRef Paterlini P, Gerken G, Nakajima E, et al. Polymerase chain reaction to detect hepatitis B virus DNA and RNA sequences in primary liver cancers from patients negative for hepatitis B surface antigen. N Engl J Med 1990;323: 80–85PubMedCrossRef
Metadata
Title
Clinical Characteristics and Surgical Outcome in Hepatocellular Carcinoma without Hepatitis B Virus Surface Antigen or Hepatitis C Virus Antibody
Authors
Kuniya Tanaka, MD, PhD
Hiroshi Shimada, MD, PhD
Kenichi Matsuo, MD
Yasuhiko Nagano, MD
Itaru Endo, MD, PhD
Shinji Togo, MD, PhD
Publication date
01-03-2007
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 3/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9299-y

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