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Pathobiological features of small hepatocellular carcinoma: correlation between tumor size and biological behavior

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Abstract

Purpose

Increasing evidence has suggested that tumor size is one of the independent prognostic factors of patients with hepatocellular carcinoma (HCC). However, the criteria used to determine when HCC should be classified as small remain controversial. Our objective was to evaluate the relationship between the size of HCC and its clinicopathological features.

Methods

A retrospective study on 618 patients who underwent partial hepatectomy for solitary HCC was performed. These patients were divided into Groups 1–5 according to the tumor diameter: ≤1, 1.1–2, 2.1–3, 3.1–5 and >5 cm, respectively. The clinicopathological variables of the patients in each group were compared statistically.

Results

Except for the microHCC (≤1 cm) which differed significantly from the other four groups in the clinicopathological variables, almost no differences existed among HCC ranging from 1 to 3 cm, or HCCs > 3 cm. If ≤3 cm was used as the cut-off point for small HCC (SHCC), and >3 cm for large HCC (LHCC), significant differences (P < 0.05–0.01) were observed between SHCC and LHCC in: histological grades I–II (48.0 vs. 19.4 %), capsular invasion (15.4 vs. 36.3%), tumor thrombi (6.9 vs. 23.5%), satellite nodules (12.3 vs. 35.5%), noninvasive growth patterns (69.6 vs. 25.4%), the overall survival (OS, 119.6 ± 34.7 vs. 68.5 ± 6.6 months), and the recurrence-free survival (RFS, 67.0 ± 16.7 vs. 29.5 ± 3.2 months). Multivariate Cox regression analyses show that tumor size >3 cm was one of the independent prognostic factors for both OS and RFS.

Conclusions

The 3 cm cutoff seems to best determine the biological behavior and clinical prognosis of patients undergoing partial hepatectomy for early stage HCC. Overall, HCC smaller than 3 cm in diameter was closely related with a better prognosis which reflected the relatively benign pathobiological features at an early developmental stage. As HCC > 3 cm exhibited a tendency towards more aggressive behavior, we suggest that HCC ≤ 3 cm in diameter should be used as a critical size of SHCC at which curative treatment achieves better long-term survivals.

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Acknowledgments

This study was supported by the National Natural Science Foundation of China, No. 30872506.

Conflict of interest statement

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript.

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Authors and Affiliations

  1. Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China

    Xin-Yuan Lu, Hui Dong, Zhi-Hong Xian, Hua Yu, Zhen Zhu & Wen-Ming Cong

  2. Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

    Wan-Yee Lau

  3. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438, China

    Tao Xi, Wan-Yee Lau, Feng Shen & Meng-Chao Wu

Authors
  1. Xin-Yuan Lu
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  2. Tao Xi
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  3. Wan-Yee Lau
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  4. Hui Dong
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  5. Zhi-Hong Xian
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  6. Hua Yu
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  8. Feng Shen
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  9. Meng-Chao Wu
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  10. Wen-Ming Cong
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Corresponding author

Correspondence to Wen-Ming Cong.

Additional information

W.-M. Cong and F. Shen contributed equally to this work.

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Lu, XY., Xi, T., Lau, WY. et al. Pathobiological features of small hepatocellular carcinoma: correlation between tumor size and biological behavior. J Cancer Res Clin Oncol 137, 567–575 (2011). https://doi.org/10.1007/s00432-010-0909-5

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  • DOI: https://doi.org/10.1007/s00432-010-0909-5

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