Tumor size predicts vascular invasion and histologic grade: Implications for selection of surgical treatment for hepatocellular carcinoma

Abstract

H epatic resection and liver transplantation are aggressive, extirpative approaches to the treatment of selected patients for hepatocellular carcinoma (HCC) and are the only known potentially curative treatment options for this disease. Resection and transplantation are largely complimentary, not competing, treatments-resection for patients with preserved liver function and transplantation for patients with compromised liver function. Within each group, selection of patients for surgical therapy is currently based on morphologic criteria such as size, number of tumors, and degree of underlying liver disease.After resection, long-term survival can be expected in patients with solitary tumors regardless of size, especially when underlying fibrosis is minimal. 1 In fact, size has no significant impact on survival when microscopic vascular invasion is absent, as survival after resection of T1 tumors larger than 10 cm in diameter is similar to survival following resection of T1 tumors less than 5 cm. 1 Similarly, long-term survival can be expected when multiple tumors without vascular invasion are completely resected. 1 The establishment of strict morphologic criteria has significantly impacted the outcome after liver transplantation for HCC. Before the adoption of these criteria for transplantation, results with liver transplantation were poor. Recurrence rates ranged from 60% to 70%, 2,3 and the 5-year survival rate was less than 30%. 4,5 Since the implementation of more stringent selection criteria, survival rates after liver transplantation have been similar to those after resection for Abbreviations: HCC, hepatocellular carcinoma; AFP, alpha-fetoprotein; HR, hazard ratio; FNA, fine-needle aspiration.

Long-term Prognosis in Hepatocellular Carcinoma Patients after Hepatectomy

“…A survival analysis was done for 1073 cases, which indicated the relations between tumor size and prognosis, that is, the bigger tumor size, the more probable coexistence of vessel invasion, and the lower tumor grade (Pawlik et al, 2005). We think that the tumor size can reflect on patients liver storage ability and limit surgical-related factors (e.g.…”

Ultrasound surveillance for early detection of hepatocellular carcinoma among patients with chronic hepatitis C

“…Such cases were suitable for receiving curative treatment such as surgical resection or radiofrequency ablation, although the actual indication depended also on the liver function reservoir of each patient [21,22]. Shorter surveillance intervals did not provide further advantages in terms of tumor size (15.8 ± 5.5 mm with 6-month interval and 16.5 ± 6.4 mm with shorter interval).…”

Validation of clinical AJCC/UICC TNM staging system for hepatocellular carcinoma: Analysis of 5,613 cases from a medical center in southern Taiwan

“…Several studies have identified that tumor size and pathological grade are correlated with microvascular invasion. [13][14][15] The risk of vascular invasion and poor prognosis that can be predicted increases with tumor size.…”