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

Lim, Chetana; Mise, Yoshihiro; Sakamoto, Yoshihiro; Yamamoto, Satoshi; Shindoh, Junichi; Ishizawa, Takeaki; Aoki, Taku; Hasegawa, Kiyoshi; Sugawara, Yasuhiko; Makuuchi, Masatoshi

doi:10.1007/s00268-014-2704-y

Cited by 66 publications

(86 citation statements)

References 38 publications

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“…Large HCCs can potentially be cured through a complete resection [23]. A 5-year OS rate of more than 50% may be achieved through surgery for tumors larger than 5 cm [22]. Postoperative disease-free survival and OS are similar between patients with large and small HCCs when the tumor is solitary [24].…”

Section: Resultsmentioning

confidence: 99%

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Surgery for Intermediate and Advanced Hepatocellular Carcinoma: A Consensus Report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014)

Hasegawa

Chen

et al. 2016

Liver Cancer

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Background: The Barcelona Clinic Liver Cancer (BCLC) staging and treatment strategy does not recommended surgery for treating BCLC stage B and C hepatocellular carcinoma (HCC). However, numerous Asia-Pacific institutes still perform surgery for this patient group. This consensus report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting aimed to share opinions and experiences pertaining to liver resection for intermediate and advanced HCCs and to provide evidence to issue recommendations for surgery in this patient group. Summary: Thirteen experts from five Asia-Pacific regions were invited to the meeting; 10 of them (Japan: 2, Taiwan: 3, South Korea: 2, Hong Kong: 1, and China: 2) voted for the final consensus. The discussion focused on evaluating the preoperative liver functional reserve and surgery for large tumors, multiple tumors, HCCs with vascular invasion, and HCCs with distant metastasis. The feasibility of future prospective randomized trials comparing surgery with transarterial chemoembolization for intermediate HCC and with sorafenib for advanced HCC was also discussed. The Child-Pugh score (9/10 experts) and indocyanine green retention rate at 15 min (8/10) were the most widely accepted methods for evaluating the preoperative liver functional reserve. All (10/10) experts agreed that portal hypertension, tumor size >5 cm, portal venous invasion, hepatic venous invasion, and extrahepatic metastasis are not absolute contraindications for the surgical resection of HCC. Furthermore, 9 of the 10 experts agreed that tumor resection may be performed for patients with >3 tumors. The limitations of surgery are associated with a poor liver functional reserve, incomplete tumor resection, and a high probability of recurrence. Key Messages: Surgery provides significant survival benefits for Asian-Pacific patients with intermediate and advanced HCCs, particularly when the liver functional reserve is favorable. However, prospective randomized controlled trials are difficult to conduct because of technical and ethical considerations.

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Section: Resultsmentioning

confidence: 99%

“…Large HCCs are typically associated with a higher incidence of vascular invasion and metastasis and higher histological grades [22]. An increased tumor size is associated with poor postoperative outcomes of HCC.…”

Section: Resultsmentioning

confidence: 99%

Surgery for Intermediate and Advanced Hepatocellular Carcinoma: A Consensus Report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014)

Hasegawa

Chen

et al. 2016

Liver Cancer

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“…With advances in surgical resection technique and lower perioperative mortality, survival after liver resection is increasing at many centers. [22][23][24][25][26] This could be particularly important in countries that experience difficulties in obtaining donor livers for transplant. Perhaps the expanded use of resection for HCC and the decreased use of transplant for smaller HCCs could release livers for other transplant indications, such as the presence of a more advanced tumor.…”

Section: Patterns Of Recurrencementioning

confidence: 99%

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Marino

Carr²

2017

Exp Clin Transplant

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The use of orthotopic liver transplant for hepatocellular carcinoma was a major advance, pioneered by Thomas E. Starzl as a way to circumvent the limitations imposed on the liver surgeon by the presence of cirrhosis and liver failure. Patients with a few small tumors, whatever their degree of liver damage, may expect prolonged survival (70% at 5 years). Patients with more advanced tumors have high recurrence rates and more limited survival, possibly due to immune suppression or pretransplant understaging of their tumors. Another possibility is that patients with micrometastases have a longer survival time, during which the metastases eventually become evident. Recent advances include the identification of patients using levels of tumor markers to allow more careful patient selection with better outcomes. The con tributions of molecular signatures and the new, effective antiviral agents are possibly significant.

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“…Presence of adverse predictors influence survival. 4,5 The 5-year overall survival rate after liver transplant is about 70%; however, 27% of patients have tumor recurrence after transplant despite fulfilling the Milan criteria. Tumor recurrence is a major limitation on survival.…”

Section: Introductionmentioning

confidence: 99%

“…3 There are several factors, including vascular invasion, satellite nodules, high differentiation grade, and underlying liver disease, that may predict outcomes after hepatic resection; in addition, tumor size is also an important prognostic factor. In a study of patients with solitary HCC, Lim and associates 4 stratified 616 resected patients with solitary HCC according to tumor size: smaller than 5 cm, 5 to 10 cm, and larger than 10 cm. The authors concluded that microvascular invasion, satellite nodules, and a less differentiated tumor were more prevalent in patients with larger tumors.…”

Section: Introductionmentioning

confidence: 99%

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Özgün

Haberal²,

Ozdemır³

et al. 2017

Exp Clin Transplant

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Primary liver cancer is the fifth most common cancer overall and the second most common cause of cancer mortality worldwide. Hepatocellular carcinoma accounts for up to 90% of all primary hepatic malignancies and represents a major international health problem. It is a complex and heterogeneous malignancy, frequently occurs in the setting of a chronically diseased organ, and has multiple confounding factors. Liver transplant for hepatocellular carcinoma has been established as a standard treatment in selected patients. Liver resection and locoregional therapies could be other options for treatment. Pathologic evaluation of hepatocellular carcinoma is a complicated process that includes tumor grading and evaluation of microvascular invasion. Although macrovascular invasion can be detected with imaging techniques, microvascular invasion is diagnosed pathologically. Pathologic evaluation provides ad ditional information about the tumor biology, using immunohistochemical and molecular methods to predict patient outcomes. Hepatocellular carcinoma requires a multidisciplinary approach to determine the most appropriate treatment, as well as requires accurate timing of various treatments for optimal outcomes.

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

Abstract: 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.

Cited by 66 publications

References 38 publications

Surgery for Intermediate and Advanced Hepatocellular Carcinoma: A Consensus Report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014)

Surgery for Intermediate and Advanced Hepatocellular Carcinoma: A Consensus Report from the 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014)

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