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Tumor size is a major determinant of prognosis of resected stage I hepatocellular carcinoma

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Abstract

Purpose

The current American Joint Committee on Cancer (AJCC) staging system for hepatocellular carcinoma (HCC) includes all solitary tumors without vascular invasion as stage I, regardless of tumor size. The aim of this study is to determine the prognostic significance of tumor size in stage I HCC patients.

Methods

A total of 230 stage I primary HCCs were selected retrospectively. Based on univariate and multivariate analyses, clinical and pathological factors correlated with 5-year disease-free survival (DFS) and 5-year overall survival (OS) were determined.

Results

Univariate and multivariate analyses showed significant correlations of low serum α-fetoprotein levels (≤20 ng/ml), small tumor size (≤3 cm), wide resection margin (≥ 1 cm), and absence of cirrhotic liver with better DFS, while smaller tumor size, and wide resection margin with better OS. Of all the parameters, tumor size is the most statistically significant markers for DFS and OS. Interestingly, liver cirrhosis exerted prognostic significance in patients with small-size tumors, while resection margin exerted prognostic significance in patients with large-size tumors.

Conclusions

Our results indicated that tumor size is the most important determinant of DFS and OS in resected primary stage I HCC patients. Therefore, we advocate redefining solitary tumors of ≤3 cm as T1a disease and tumors >3 cm as T1b disease. This stratification of stage I HCC patients could aid in the determination of prognosis and the development of superior protocols for patient management. However, further analysis of big registry cohorts is needed to establish a common consensus.

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Disclosure of commercial interest

None

Conflicts of interest

The authors declare no conflicts of interest regarding the subject of this study.

Author contributions

Study conception and design was done by WJH YMJ RHY. Acquisition of data was performed by FYBS PLL. Analysis and interpretation of data was conducted by WJH YMJ HSL RHY. Drafting of manuscript was written by WJH HSL. Critical revision of manuscript was made YMJ RHY.

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Authors and Affiliations

  1. Graduate Institute of Pathology, College of Medicine, National Taiwan University, No. 1, Jen-Ai Road, Section 1, Taipei, 10051, Taiwan

    Wei-Ju Huang, Yung-Ming Jeng & Po-Lin Lai

  2. Department of Nursing, Hsin-Sheng College of Medical Care and Management, No. 418, Gao** Section, Zhongfeng Road, Longtan Township, Taoyuan County, 32544, Taiwan

    Wei-Ju Huang

  3. Department of Pathology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10051, Taiwan

    Yung-Ming Jeng & Po-Lin Lai

  4. Department of Pathology, College of Medicine, National Taiwan University, No. 1, Jen-Ai Road, Section 1, Taipei, 10051, Taiwan

    Yung-Ming Jeng

  5. Department of Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10051, Taiwan

    Hong-Shiee Lai & Ray-Hwang Yuan

  6. Department of Surgery, College of Medicine, National Taiwan University, No. 1, Jen-Ai Road, Section 1, Taipei, 10051, Taiwan

    Hong-Shiee Lai & Ray-Hwang Yuan

  7. Department of Biomedical Science, University of Illinois College of Medicine, 1601 Parkview Ave, Rockford, IL, 61107, USA

    Fang-Yu Bonnie Sheu

  8. Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10051, Taiwan

    Ray-Hwang Yuan

  9. Department of Surgery, National Taiwan University Hospital and College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 10051, Taiwan

    Ray-Hwang Yuan

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  1. Wei-Ju Huang
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Correspondence to Ray-Hwang Yuan.

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Huang, WJ., Jeng, YM., Lai, HS. et al. Tumor size is a major determinant of prognosis of resected stage I hepatocellular carcinoma. Langenbecks Arch Surg 400, 725–734 (2015). https://doi.org/10.1007/s00423-015-1329-4

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  • DOI: https://doi.org/10.1007/s00423-015-1329-4

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