Long-term survival in patients with T2 hepatocellular carcinoma after primary curative resection can be further stratified by tumor size

Abstract

Insufficient data are available regarding the validation of long-term survival in patients with T2 (solitary tumor with microvascular invasion [MVI] or multiple tumors, none >5 cm) hepatocellular carcinoma (HCC) after primary hepatectomy. We aim to evaluate the survival and relevant risk factors for T2 HCC patients. Between 2001 and 2007, 312 T2 HCC patients who underwent primary hepatectomy were included. Survival was estimated using the Kaplan-Meier method and compared using Cox proportional hazard model with adjusted independent prognostic factors. The 1, 3, and 5-year overall survival rates of patients with MVI were 85.7%, 68.7%, and 64.8%, respectively; these were inferior to the rates in patients without MVI, which were 93.0%, 89.3%, and 73.7%, respectively (P = 0.037). Within the with-MVI group, the survival rate of patients with tumor sizes ≥ 5 cm was inferior to that of patients with tumors <5 cm (overall, P = 0.01; recurrence-free, P < 0.0001). For patients with the largest tumors in the <5-cm group, those without MVI tended to have a higher probability of recurrence for 2 years after resection (P = 0.088) but a similar overall survival rate relative to those with MVI (P = 0.31). The crude metastasis-free survival was higher in the without-MVI group than in the with-MVI group (P = 0.012). The T2 HCC category comprised heterogeneous patients with differences in survival rates. Extrahepatic recurrence occurred more frequently in patients with MVI than in those without MVI. These results provide evidence for an updated definition of T2 HCC.

FIGURE 1

Patient selection process and inclusion/exclusion criteria. HCC = hepatocellular carcinoma, MVI = microvascular invasion, T2 = solitary tumor with MVI or multiple tumors, none >5 cm.

FIGURE 2

Kaplan–Meier curves for overall survival in patients who underwent primary curative resection for T2 HCC. HCC = hepatocellular carcinoma, MVI = microvascular invasion, T2 = solitary tumor with MVI or multiple tumors, none >5 cm.

FIGURE 3

(A) Kaplan–Meier curves for disease-free survival in patients who underwent primary curative resection for T2 HCC. (B) Kaplan–Meier curves for postrecurrence survival in patients who underwent primary curative resection for T2 HCC. (C) Kaplan–Meier curves for metastasis-free survival in patients who underwent primary curative resection for T2 HCC. HCC = hepatocellular carcinoma, MVI = microvascular invasion, T2 = solitary tumor with MVI or multiple tumors, none >5 cm.

FIGURE 4

(A) Comparison of the Kaplan–Meier curves for overall survival in patients who underwent primary curative resection for T2 HCC. (B) Comparison of the Kaplan–Meier curves for disease-free survival in patients who underwent primary curative resection for T2 HCC. (C) Comparison of the Kaplan–Meier curves for postrecurrence survival in patients who underwent primary curative resection for T2 HCC. HCC = hepatocellular carcinoma, MVI = microvascular invasion, T2 = solitary tumor with MVI or multiple tumors, none >5 cm.