Resection of hepatocellular cancer ≤2 cm: Results from two Western centers

Abstract

Asian series have shown 5 year survival of ∼70% after resection of hepatocellular cancer (HCC) <2cm. Western outcomes with resection have not been as good. In addition ablation of HCC ≤ 2cm has been shown to achieve competitive results leaving the role of resection unclear in these patients. Records of patients undergoing resection at two Western centers between 1/1990 and 12/2009 were reviewed. Patients with a single HCC ≤ 2cm on pathology were included. Thirty clinical variables including demographics, liver function, tumor characteristics, nature of the surgery, and the surrounding liver were examined. An exploratory statistical analysis was conducted to determine variables associated with recurrence and survival. The study included 132 patients with a median follow-up of 37.5 months. There was 1 (<1%) 90-day mortality. There were 32 deaths with a median survival of 74.5 months and 5-year survival of 70% (63% in cirrhotics). Median time-to-recurrence was 31.6 months and 5-year recurrence rate was 68%. Presence of satellites (HR=2.46, p=0.031) and platelet count <150,000/μl (HR=2.37, p=0.026) were independently associated with survival. Presence of satellites (HR=2.79, p=0.003), cirrhosis (HR=2.3, p=0.010), and non-anatomic resection (HR=1.79, p=0.031) were independently associated with recurrence. Patients with a single HCC ≤ 2cm and platelet count ≥150,000/μl achieved median and 5-year survivals of 138 months and 81%, respectively. Conclusion Resection of HCC ≤ 2cm is safe and achieves excellent results in Western centers. Recurrence continues to be a significant problem. Presence of satellites, platelet count, anatomic resection and cirrhosis are associated with outcomes after resection even among such early tumors. Resection should continue to be considered a primary treatment modality in patients with small HCC and well preserved liver function.

Hepatocellular carcinoma treatment strategies – a case-based review

“…The presence of splenomegaly (major diameter > 12 cm) or esophageal varices with a platelet count of < 100,000/mm 3 correlate with the same endpoints and are easier to identify [27] .…”

“…Of the ava function [1, necrosis ge satellite les region of t ablation co to multifoc bolization optimal pat All treatm complicatio significanc tumor loca technique i confined v limitations [18,27] . There es supporting R dard of care f be clearly seen n the surround latest improve erstandable tha HCC > 3 cm, t m [45,46] .…”

Host antitumor resistance improved by the macrophage polarization in a chimera model of patients with HCC

“…1 The management of HCC has substantially changed in the past few decades. Earlier, HCC was treated by surgical resection, but multifocal HCC often arise synchronously or metachronously as new tumors or as intrahepatic metastases of the primary cancer, leading to high mortality rates in HCC patients [2][3][4] ; therefore, new strategies to treat HCC are needed in addition to the current therapies.…”

Toward a rational management of very early hepatocellular carcinoma

“…This issue of HEPATOLOGY publishes the result of a combined effort from two large referral centers, based in New York and Milan, 9 reporting on the outcomes and prognostic factors of surgical resection in patients with HCC <2 cm in diameter. In this large western series, survival at 5 years was 70% and was influenced by the presence of satellites and by platelet count, with the best results obtained in patients with more than 150,000 platelets (83% survival at 5 years).…”

“…Roayaie et al also showed that at least one third of these early tumors present with microvascular invasion or satellites. 9 On the other hand, approximately 5% of these lesions turn out to be either benign lesion or hepatocholangiocarcinomas. 15 Thus, surgical resection has the advantage of confirming the diagnosis and providing important pathologic information that may affect the following treatment strategy (i.e., prevention of recurrence, indication, and timing for transplantation).…”