Impact of Tumor Size on Hepatectomy Outcomes in Hepatocellular Carcinoma: a Nationwide Propensity Score Matching Analysis

Overview

Journal Ann Surg Treat Res

Specialty General Surgery

Date 2022 Apr 27

PMID 35475226

Authors

Suk Kyun Hong

Kwang-Woong Lee

Sola Lee

Su Young Hong

Sanggyun Suh

Eui Soo Han

YoungRok Choi

Nam-Joon Yi

Kyung-Suk Suh

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to compare surgical outcomes after liver resection for hepatocellular carcinoma (HCC) according to tumor size using a large, nationwide cancer registry-based cohort and propensity score matching.

Methods: From 2008 to 2015, a total of 12,139 patients were diagnosed with liver cancer and registered in the Korean Primary Liver Cancer Registry. Patients without distant metastasis who underwent hepatectomy as a primary treatment were selected. We performed 1:1 propensity score matching between the small (<5 cm), large (≥5 cm and <10 cm), and huge (≥10 cm) groups.

Results: Overall, 265 patients in the small and large groups were compared, and 64 patients each in the large and huge groups were compared. The overall and progression-free survival rates were significantly lower in the large group than in the small group (P < 0.001 and P < 0.001, respectively). Overall survival tended to be poorer in the huge group than in the large group (P = 0.051). The progression-free survival rate was significantly lower in the huge group than in the large group (P = 0.002).

Conclusion: Although primary liver resection can be considered even in patients with huge HCC, greater caution with careful screening for recurrence is needed.

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References

Wang G, Lu X, Du Q, Zhang G, Wang D, Wang Q . Diagnostic value of the γ-glutamyltransferase and alanine transaminase ratio, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist II in hepatitis B virus-related hepatocellular carcinoma. Sci Rep. 2020; 10(1):13519. PMC: 7419311. DOI: 10.1038/s41598-020-70241-5. View

. 2018 Korean Liver Cancer Association-National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Gut Liver. 2019; 13(3):227-299. PMC: 6529163. DOI: 10.5009/gnl19024. View

Wakayama K, Kamiyama T, Yokoo H, Orimo T, Shimada S, Einama T . Huge hepatocellular carcinoma greater than 10 cm in diameter worsens prognosis by causing distant recurrence after curative resection. J Surg Oncol. 2017; 115(3):324-329. DOI: 10.1002/jso.24501. View

Allemann P, Demartines N, Bouzourene H, Tempia A, Halkic N . Long-term outcome after liver resection for hepatocellular carcinoma larger than 10 cm. World J Surg. 2012; 37(2):452-8. DOI: 10.1007/s00268-012-1840-5. View

Yoon J, Lee H, Kim H, Sinn D, Lee D, Hong S . Hepatocellular Carcinoma in Korea: an Analysis of the 2015 Korean Nationwide Cancer Registry. J Liver Cancer. 2023; 21(1):58-68. PMC: 10035724. DOI: 10.17998/jlc.21.1.58. View

Lin Y, Lee M, Yang H, Jen C, You S, Wang L . Predictability of liver-related seromarkers for the risk of hepatocellular carcinoma in chronic hepatitis B patients. PLoS One. 2013; 8(4):e61448. PMC: 3629190. DOI: 10.1371/journal.pone.0061448. View

Tarao K, Rino Y, Ohkawa S, Tamai S, Miyakawa K, Takakura H . Close association between high serum alanine aminotransferase levels and multicentric hepatocarcinogenesis in patients with hepatitis C virus-associated cirrhosis. Cancer. 2002; 94(6):1787-95. DOI: 10.1002/cncr.10391. View

Minagawa M, Ikai I, Matsuyama Y, Yamaoka Y, Makuuchi M . Staging of hepatocellular carcinoma: assessment of the Japanese TNM and AJCC/UICC TNM systems in a cohort of 13,772 patients in Japan. Ann Surg. 2007; 245(6):909-22. PMC: 1876960. DOI: 10.1097/01.sla.0000254368.65878.da. View

Hwang S, Lee Y, Kim K, Ahn C, Moon D, Ha T . Long-Term Outcome After Resection of Huge Hepatocellular Carcinoma ≥ 10 cm: Single-Institution Experience with 471 Patients. World J Surg. 2015; 39(10):2519-28. DOI: 10.1007/s00268-015-3129-y. View

10.

Huang J, Zhang Y, Peng Z, Gao H, Xu L, Jiao L . A modified TNM-7 staging system to better predict the survival in patients with hepatocellular carcinoma after hepatectomy. J Cancer Res Clin Oncol. 2013; 139(10):1709-19. DOI: 10.1007/s00432-013-1497-y. View

11.

Ettorre G, Levi Sandri G, Colasanti M, Masciana G, de Werra E, Santoro R . Liver resection for hepatocellular carcinoma ≥5 cm. Transl Gastroenterol Hepatol. 2017; 2:22. PMC: 5388623. DOI: 10.21037/tgh.2017.03.13. View

12.

Si Y, Wang X, Fan G, Wang C, Zheng Y, Song X . Value of AFP and PIVKA-II in diagnosis of HBV-related hepatocellular carcinoma and prediction of vascular invasion and tumor differentiation. Infect Agent Cancer. 2020; 15(1):70. PMC: 7684907. DOI: 10.1186/s13027-020-00337-0. View

13.

Goh B, Chow P, Teo J, Wong J, Chan C, Cheow P . Number of nodules, Child-Pugh status, margin positivity, and microvascular invasion, but not tumor size, are prognostic factors of survival after liver resection for multifocal hepatocellular carcinoma. J Gastrointest Surg. 2014; 18(8):1477-85. DOI: 10.1007/s11605-014-2542-0. View

14.

Bai D, Zhang C, Chen P, Jin S, Jiang G . The prognostic correlation of AFP level at diagnosis with pathological grade, progression, and survival of patients with hepatocellular carcinoma. Sci Rep. 2017; 7(1):12870. PMC: 5634482. DOI: 10.1038/s41598-017-12834-1. View

15.

Andreou A, Vauthey J, Cherqui D, Zimmitti G, Ribero D, Truty M . Improved long-term survival after major resection for hepatocellular carcinoma: a multicenter analysis based on a new definition of major hepatectomy. J Gastrointest Surg. 2012; 17(1):66-77. PMC: 3880185. DOI: 10.1007/s11605-012-2005-4. View

16.

Fung J, Cheung K, Wong D, Mak L, To W, Seto W . Long-term outcomes and predictive scores for hepatocellular carcinoma and hepatitis B surface antigen seroclearance after hepatitis B e-antigen seroclearance. Hepatology. 2018; 68(2):462-472. DOI: 10.1002/hep.29874. View

17.

Noh J, Kim T, Ahn K, Kim Y, Kang K . Prognostic factors after hepatic resection for the single hepatocellular carcinoma larger than 5 cm. Ann Surg Treat Res. 2016; 91(3):104-11. PMC: 5016599. DOI: 10.4174/astr.2016.91.3.104. View

18.

Zhang H, Yuan S, Dai S, Zhang J, Huang X, Lu C . Tumor size does not independently affect long-term survival after curative resection of solitary hepatocellular carcinoma without macroscopic vascular invasion. World J Surg. 2013; 38(4):947-57. DOI: 10.1007/s00268-013-2365-2. View

19.

Torzilli G, Belghiti J, Kokudo N, Takayama T, Capussotti L, Nuzzo G . A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC East-West study group. Ann Surg. 2013; 257(5):929-37. DOI: 10.1097/SLA.0b013e31828329b8. View

20.

Zhou Y, Li B, Xu D, Yang J . Safety and efficacy of partial hepatectomy for huge (≥10 cm) hepatocellular carcinoma: a systematic review. Med Sci Monit. 2011; 17(3):RA76-83. PMC: 3524737. DOI: 10.12659/msm.881443. View