Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Apr;57(4):1426-35.
doi: 10.1002/hep.25832. Epub 2013 Jan 25.

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

Sasan Roayaie  1 , Khaled Obeidat, Carlo Sposito, Luigi Mariani, Sherrie Bhoori, Alessandro Pellegrinelli, Daniel Labow, Josep M Llovet, Myron Schwartz, Vincenzo Mazzaferro
Affiliations

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

Sasan Roayaie et al. Hepatology. 2013 Apr.

Abstract

Asian series have shown a 5-year survival rate of ≈70% after resection of hepatocellular carcinoma (HCC) ≤2 cm. Western outcomes with resection have not been as good. In addition, ablation of HCC ≤2 cm has been shown to achieve competitive results, leaving the role of resection in these patients unclear. Records of patients undergoing resection at two Western centers between January 1990 and December 2009 were reviewed. Patients with a single HCC ≤2 cm on pathologic analysis 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 one (<1%) 90-day mortality. There were 32 deaths with a median survival of 74.5 months and a 5-year survival rate of 70% (63% in patients with cirrhosis). The median time to recurrence was 31.6 months and the 5-year recurrence rate was 68%. Presence of satellites (hazard ratio [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 nonanatomic resection (HR, 1.79; P = 0.031) were independently associated with recurrence. Patients with a single HCC ≤2 cm and platelet count ≥150,000/μL achieved a median survival of 138 months and a 5-year survival rate of 8%, respectively.

Conclusion: Resection of HCC ≤2 cm 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Results for the entire cohort. Overall survival (A) and time-to-recurrence (B) for 132 patients with HCC ≤2cm undergoing hepatic resection at two Western centers. The instantaneous risk of death and recurrence over time (C). Relationship between platelet count as a continuous variable and survival at 5 years (regression coefficient -0.00764 ±0.00373; p=0.0404) (D).
Figure 1
Figure 1
Results for the entire cohort. Overall survival (A) and time-to-recurrence (B) for 132 patients with HCC ≤2cm undergoing hepatic resection at two Western centers. The instantaneous risk of death and recurrence over time (C). Relationship between platelet count as a continuous variable and survival at 5 years (regression coefficient -0.00764 ±0.00373; p=0.0404) (D).
Figure 1
Figure 1
Results for the entire cohort. Overall survival (A) and time-to-recurrence (B) for 132 patients with HCC ≤2cm undergoing hepatic resection at two Western centers. The instantaneous risk of death and recurrence over time (C). Relationship between platelet count as a continuous variable and survival at 5 years (regression coefficient -0.00764 ±0.00373; p=0.0404) (D).
Figure 1
Figure 1
Results for the entire cohort. Overall survival (A) and time-to-recurrence (B) for 132 patients with HCC ≤2cm undergoing hepatic resection at two Western centers. The instantaneous risk of death and recurrence over time (C). Relationship between platelet count as a continuous variable and survival at 5 years (regression coefficient -0.00764 ±0.00373; p=0.0404) (D).
Figure 2
Figure 2
Results of sub-group analyses. Overall survival of patients stratified according to platelet count (<100,000, 100-149,000 and ≥150,000/μl) (A). Time-to-recurrence stratified by anatomic vs. nonanatomic resection (B). Overall survival of patients undergoing resection of HCC ≤ 2cm stratified according to presence of cirrhosis (C). Time-to-recurrence stratified according to presence of microvascular invasion and /or satellites – BCLC 0 / Japanese T1 versus others (D). Overall survival (E) and time-to-recurrence (F) for patients with satellite tumors stratified by anatomic vs. nonanatomic resection.
Figure 2
Figure 2
Results of sub-group analyses. Overall survival of patients stratified according to platelet count (<100,000, 100-149,000 and ≥150,000/μl) (A). Time-to-recurrence stratified by anatomic vs. nonanatomic resection (B). Overall survival of patients undergoing resection of HCC ≤ 2cm stratified according to presence of cirrhosis (C). Time-to-recurrence stratified according to presence of microvascular invasion and /or satellites – BCLC 0 / Japanese T1 versus others (D). Overall survival (E) and time-to-recurrence (F) for patients with satellite tumors stratified by anatomic vs. nonanatomic resection.
Figure 2
Figure 2
Results of sub-group analyses. Overall survival of patients stratified according to platelet count (<100,000, 100-149,000 and ≥150,000/μl) (A). Time-to-recurrence stratified by anatomic vs. nonanatomic resection (B). Overall survival of patients undergoing resection of HCC ≤ 2cm stratified according to presence of cirrhosis (C). Time-to-recurrence stratified according to presence of microvascular invasion and /or satellites – BCLC 0 / Japanese T1 versus others (D). Overall survival (E) and time-to-recurrence (F) for patients with satellite tumors stratified by anatomic vs. nonanatomic resection.
Figure 2
Figure 2
Results of sub-group analyses. Overall survival of patients stratified according to platelet count (<100,000, 100-149,000 and ≥150,000/μl) (A). Time-to-recurrence stratified by anatomic vs. nonanatomic resection (B). Overall survival of patients undergoing resection of HCC ≤ 2cm stratified according to presence of cirrhosis (C). Time-to-recurrence stratified according to presence of microvascular invasion and /or satellites – BCLC 0 / Japanese T1 versus others (D). Overall survival (E) and time-to-recurrence (F) for patients with satellite tumors stratified by anatomic vs. nonanatomic resection.
Figure 2
Figure 2
Results of sub-group analyses. Overall survival of patients stratified according to platelet count (<100,000, 100-149,000 and ≥150,000/μl) (A). Time-to-recurrence stratified by anatomic vs. nonanatomic resection (B). Overall survival of patients undergoing resection of HCC ≤ 2cm stratified according to presence of cirrhosis (C). Time-to-recurrence stratified according to presence of microvascular invasion and /or satellites – BCLC 0 / Japanese T1 versus others (D). Overall survival (E) and time-to-recurrence (F) for patients with satellite tumors stratified by anatomic vs. nonanatomic resection.
Figure 2
Figure 2
Results of sub-group analyses. Overall survival of patients stratified according to platelet count (<100,000, 100-149,000 and ≥150,000/μl) (A). Time-to-recurrence stratified by anatomic vs. nonanatomic resection (B). Overall survival of patients undergoing resection of HCC ≤ 2cm stratified according to presence of cirrhosis (C). Time-to-recurrence stratified according to presence of microvascular invasion and /or satellites – BCLC 0 / Japanese T1 versus others (D). Overall survival (E) and time-to-recurrence (F) for patients with satellite tumors stratified by anatomic vs. nonanatomic resection.
See this image and copyright information in PMC

Comment in

References

    1. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet. 2003;362(9399):1907–1917. - PubMed
    1. Liver Cancer Study Group of Japan. General Rules for the Clinical and Pathological Study of Primary Liver Cancer. Kanehara. 2003 - PubMed
    1. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, et al. Clinical management of hepatocellular carcinoma. conclusions of the barcelona-2000 EASL conference. european association for the study of the liver. J Hepatol. 2001;35(3):421–430. - PubMed
    1. Bruix J, Sherman M. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2005;42(5):1208–1236. - PubMed
    1. Forner A, Vilana R, Ayuso C, Bianchi L, Sole M, Ayuso JR, Boix L, et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology. 2008;47(1):97–104. - PubMed

Publication types

MeSH terms