In Reply We thank Braillon and Regimbeau for their interest in our 2018 publication titled “Risk Factors, Patterns, and Outcomes of Late Recurrence After Liver Resection for Hepatocellular Carcinoma: A Multicenter Study From China.”1 As Braillon and Regimbeau highlighted in their letter, smoking may be an important contributing factor for the development of hepatocellular carcinoma (HCC). We agree with this point, but we believe that smoking should not be considered as the main cause for HCC development, which did not contribute much to the occurrence of late recurrence after curative resection for HCC. Considering the retrospective nature of our study, all data in our study came from a multicenter database, which actually documented medical diagnosis but not the real status of lifestyle exposures.2 As for smoking status, the length and amount of smoking are difficult to determine from the medical record. It is also not appropriate to simply divide patients into smokers and nonsmokers with a certain cutoff value and then explore the association of smoking with late recurrence after HCC resection. As we think, large-scale epidemiological studies that incorporate both medical record data and lifestyle factor information are required to address the issue.
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Xing H, Xu X, Yang T. Care After Liver Resection for Hepatocellular Carcinoma—Reply. JAMA Surg. Published online March 20, 2019154(6):569. doi:10.1001/jamasurg.2019.0150
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