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Above 5 cm, Size Does Not Matter Anymore in Patients with Hepatocellular Carcinoma

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Abstract

Background

Solitary hepatocellular carcinoma (HCC) is a good candidate for surgical resection. However, the significance of the size of the tumor in solitary HCC remains unclear.

Objective

The aim of this study was to evaluate the impact of tumor size on overall and recurrence-free survival of patients with solitary HCC.

Materials

We retrospectively reviewed 616 patients with histologically confirmed solitary HCC who underwent curative surgical resection between 1994 and 2010. The characteristics and prognosis of patients with HCC were analyzed stratified by tumor size.

Results

A total of 403 patients (65 %) had tumors <5 cm, 172 (28 %) had tumors between 5 and 10 cm, and 41 (7 %) had tumors >10 cm. The incidence of microvascular invasion, satellite nodules, and advanced tumor grade significantly increased with tumor size. The 5-year overall and recurrence-free survival rates of HCC <5 cm were 69.6 % and 32 %, respectively, which were significantly better than those of HCC between 5 and 10 cm (58 % and 26 %, respectively) and HCC >10 cm (53 % and 24 %, respectively). On multivariate analysis, cirrhosis (p = 0.0307), Child–Pugh B (p = 0.0159), indocyanine green retention rate at 15 min >10 % (p = 0.0071), microvascular invasion (p < 0.0001), and satellite nodules (p = 0.0009) were independent predictors of poor survival, whereas tumor size >5 cm was not.

Conclusion

Although recurrence rates are high, surgical resection for solitary HCC offers good overall survival. Tumor size was not a prognostic factor. Solitary large HCC >10 cm would be a good candidate for hepatectomy as well as solitary HCC between 5 and 10 cm.

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References

  1. Rahbari NN, Mehrabi A, Mollberg NM, Muller SA, Koch M, Buchler MW, Weitz J (2011) Hepatocellular carcinoma: current management and perspectives for the future. Ann Surg 253(3):453–469

    Article  PubMed  Google Scholar 

  2. Wang Y, Yuan L, Ge RL, Sun Y, Wei G (2010) Survival benefit of surgical treatment for hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus: results of a retrospective cohort study. Ann Surg Oncol 20(3):914–922

    Article  Google Scholar 

  3. Jonas S, Bechstein WO, Steinmuller T, Herrmann M, Radke C, Berg T, Settmacher U, Neuhaus P (2001) Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology 33(5):1080–1086

    Article  PubMed  CAS  Google Scholar 

  4. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, Ammatuna M, Morabito A, Gennari L (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334(11):693–699

    Article  PubMed  CAS  Google Scholar 

  5. Tsai TJ, Chau GY, Lui WY, Tsay SH, King KL, Loong CC, Hsia CY, Wu CW (2000) Clinical significance of microscopic tumor venous invasion in patients with resectable hepatocellular carcinoma. Surgery 127(6):603–608

    Article  PubMed  CAS  Google Scholar 

  6. Vauthey JN, Lauwers GY, Esnaola NF, Do KA, Belghiti J, Mirza N, Curley SA, Ellis LM, Regimbeau JM, Rashid A, Cleary KR, Nagorney DM (2002) Simplified staging for hepatocellular carcinoma. J Clin Oncol 20(6):1527–1536

    Article  PubMed  Google Scholar 

  7. Liver Cancer Study Group of Japan (2008) General rules for the clinical and pathological study of primary liver cancer, 5th Japanese edition edn. Kanehara, Tokyo

    Google Scholar 

  8. American Joint Committee on Cancer (AJCC) (2009) Cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  9. Shindoh J, Andreou A, Aloia TA, Zimmitti G, Lauwers GY, Laurent A, Nagorney DM, Belghiti J, Cherqui D, Poon RT, Kokudo N, Vauthey JN (2012) Microvascular invasion does not predict long-term survival in hepatocellular carcinoma up to 2 cm: reappraisal of the staging system for solitary tumors. Ann Surg Oncol 20(4):1223–1229

    Article  PubMed  Google Scholar 

  10. Ariizumi S, Kotera Y, Takahashi Y, Katagiri S, Yamamoto M (2012) Impact of hepatectomy for huge solitary hepatocellular carcinoma. J Surg Oncol 107(4):408–413

    Article  PubMed  Google Scholar 

  11. Pawlik TM, Poon RT, Abdalla EK, Zorzi D, Ikai I, Curley SA, Nagorney DM, Belghiti J, Ng IO, Yamaoka Y, Lauwers GY, Vauthey JN (2005) Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Arch Surg 140(5):450–457 discussion 457–458

    Article  PubMed  Google Scholar 

  12. Shimada K, Sakamoto Y, Esaki M, Kosuge T (2008) Role of a hepatectomy for the treatment of large hepatocellular carcinomas measuring 10 cm or larger in diameter. Langenbecks Arch Surg 393(4):521–526

    Article  PubMed  Google Scholar 

  13. European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56(4):908–943

    Google Scholar 

  14. Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42(5):1208–1236

    Article  PubMed  Google Scholar 

  15. Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, Kawasaki S (1993) Surgery for small liver cancers. Semin Surg Oncol 9(4):298–304

    Article  PubMed  CAS  Google Scholar 

  16. Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161(4):346–350

    PubMed  CAS  Google Scholar 

  17. Takayama T, Makuuchi M, Watanabe K, Kosuge T, Takayasu K, Yamazaki S, Hasegawa H (1991) A new method for mapping hepatic subsegment: counterstaining identification technique. Surgery 109(2):226–229

    PubMed  CAS  Google Scholar 

  18. Strasberg SM, Phillips C (2012) Use and dissemination of the Brisbane 2000 nomenclature of liver anatomy and resections. Ann Surg 257(3):377–382

    Article  Google Scholar 

  19. Imamura H, Shimada R, Kubota M, Matsuyama Y, Nakayama A, Miyagawa S, Makuuchi M, Kawasaki S (1999) Preoperative portal vein embolization: an audit of 84 patients. Hepatology 29(4):1099–1105

    Article  PubMed  CAS  Google Scholar 

  20. Ishizawa T, Kokudo N, Makuuchi M (2008) Right hepatectomy for hepatocellular carcinoma: is the anterior approach superior to the conventional approach? Ann Surg 247(2):390–391 author reply 391–392

    Article  PubMed  Google Scholar 

  21. Liu CL, Fan ST, Lo CM, Tso WK, Poon RT, Lam CM, Wong J (2001) Management of spontaneous rupture of hepatocellular carcinoma: single-center experience. J Clin Oncol 19(17):3725–3732

    PubMed  CAS  Google Scholar 

  22. Aoki T, Imamura H, Hasegawa K, Matsukura A, Sano K, Sugawara Y, Kokudo N, Makuuchi M (2004) Sequential preoperative arterial and portal venous embolizations in patients with hepatocellular carcinoma. Arch Surg 139(7):766–774

    Article  PubMed  Google Scholar 

  23. Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, Sugawara Y, Minagawa M, Takayama T, Kawasaki S, Makuuchi M (2003) Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol 38(2):200–207

    Article  PubMed  Google Scholar 

  24. Pawlik TM, Delman KA, Vauthey JN, Nagorney DM, Ng IO, Ikai I, Yamaoka Y, Belghiti J, Lauwers GY, Poon RT, Abdalla EK (2005) Tumor size predicts vascular invasion and histologic grade: implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl 11(9):1086–1092

    Article  PubMed  Google Scholar 

  25. Chen XP, Qiu FZ, Wu ZD, Zhang BX (2004) Chinese experience with hepatectomy for huge hepatocellular carcinoma. Br J Surg 91(3):322–326

    Article  PubMed  CAS  Google Scholar 

  26. Lee NH, Chau GY, Lui WY, King KL, Tsay SH, Wu CW (1998) Surgical treatment and outcome in patients with a hepatocellular carcinoma greater than 10 cm in diameter. Br J Surg 85(12):1654–1657

    Article  PubMed  CAS  Google Scholar 

  27. Lee SG, Hwang S, Jung JP, Lee YJ, Kim KH, Ahn CS (2007) Outcome of patients with huge hepatocellular carcinoma after primary resection and treatment of recurrent lesions. Br J Surg 94(3):320–326

    Article  PubMed  CAS  Google Scholar 

  28. Liau KH, Ruo L, Shia J, Padela A, Gonen M, Jarnagin WR, Fong Y, D’Angelica MI, Blumgart LH, DeMatteo RP (2005) Outcome of partial hepatectomy for large (>10 cm) hepatocellular carcinoma. Cancer 104(9):1948–1955

    Article  PubMed  Google Scholar 

  29. Mok KT, Wang BW, Lo GH, Liang HL, Liu SI, Chou NH, Tsai CC, Chen IS, Yeh MH, Chen YC (2003) Multimodality management of hepatocellular carcinoma larger than 10 cm. J Am Coll Surg 197(5):730–738

    Article  PubMed  Google Scholar 

  30. Nagano Y, Tanaka K, Togo S, Matsuo K, Kunisaki C, Sugita M, Morioka D, Miura Y, Kubota T, Endo I, Sekido H, Shimada H (2005) Efficacy of hepatic resection for hepatocellular carcinomas larger than 10 cm. World J Surg 29(1):66–71. doi:10.1007/s00268-004-7509-y

    Article  PubMed  Google Scholar 

  31. Shah SA, Wei AC, Cleary SP, Yang I, McGilvray ID, Gallinger S, Grant DR, Greig PD (2007) Prognosis and results after resection of very large (>or = 10 cm) hepatocellular carcinoma. J Gastrointest Surg 11(5):589–595

    Article  PubMed  Google Scholar 

  32. Yeh CN, Lee WC, Chen MF (2003) Hepatic resection and prognosis for patients with hepatocellular carcinoma larger than 10 cm: two decades of experience at Chang Gung memorial hospital. Ann Surg Oncol 10(9):1070–1076

    Article  PubMed  Google Scholar 

  33. Shindoh J, Hasegawa K, Inoue Y, Ishizawa T, Nagata R, Aoki T, Sakamoto Y, Sugawara Y, Makuuchi M, Kokudo N (2013) Risk factors of post-operative recurrence and adequate surgical approach to improve long-term outcomes of hepatocellular carcinoma. HPB (Oxford) 15(1):31–39

    Article  Google Scholar 

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Conflict of interest

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Authors and Affiliations

  1. Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 1138655, Japan

    Chetana Lim, Yoshihiro Mise, Yoshihiro Sakamoto, Satoshi Yamamoto, Junichi Shindoh, Takeaki Ishizawa, Taku Aoki, Kiyoshi Hasegawa, Yasuhiko Sugawara & Norihiro Kokudo

  2. Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, Creteil, France

    Chetana Lim

  3. Division of Hepato-Biliary-Pancreatic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan

    Masatoshi Makuuchi

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  1. Chetana Lim
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  2. Yoshihiro Mise
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  3. Yoshihiro Sakamoto
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  4. Satoshi Yamamoto
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  6. Takeaki Ishizawa
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  11. Norihiro Kokudo
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Correspondence to Norihiro Kokudo.

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Lim, C., Mise, Y., Sakamoto, Y. et al. Above 5 cm, Size Does Not Matter Anymore in Patients with Hepatocellular Carcinoma. World J Surg 38, 2910–2918 (2014). https://doi.org/10.1007/s00268-014-2704-y

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  • DOI: https://doi.org/10.1007/s00268-014-2704-y

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