Tumor size of hepatocellular carcinoma in noncirrhotic liver: A controversial predictive factor for outcome after resection

Background: Hepatocellular carcinoma in noncirrhotic liver (NC-HCC) presents usually with large size, which is seen as a contraindication to liver transplantation (LT) or even resection. The objective of our single-center study was to identify prognostic factors following resection of large NC-HCCs and to subsequently devise a treatment strategy (including LT) in selected patients. Methods: From 2000 to 2010, 89 patients who had hepatic resection for NC-HCC (large >= 8 cm in 52) were analyzed with regard to pathological findings, postoperative and long-term outcome. Results: Five patients died postoperatively. After a mean follow-up of 35 +/- 30 months, NC-HCC recurred in 36 patients (26/47 survivors-in group 8 cm+, 10/37 in group 8 cm-; p = 0.007). Five-year overall (OS) and disease-free survival (DFS) rates were significantly worse for group 8 cm+ (43.4% vs. 89.2% and 39.3% vs. 60.7% for group 8 cm-, p < 0.05). Seven patients underwent re-hepatectomy and/or LT for isolated intrahepatic recurrence, with 5-year DFS of 57.1%. In a multivariate analysis, the factors associated with poor OS and DFS were vascular invasion and tumor size >= 8 cm in the overall population and vascular invasion, fibrosis and satellite nodules in group 8 cm+. Adjuvant transarterial chemotherapy was a protective factor in group 8 cm+. In 22 isolated NC-HCC cases with no vascular invasion or fibrosis, tumor size had no impact on five-year DFS (85%). Conclusions: Although patients with NC-HCC >= 8 cm had a poorer prognosis, the absence of vascular invasion or fibrosis was associated with excellent survival, regardless of the tumor size. In recurrent patients, aggressive treatment (including LT) can be considered. (C) 2012 Elsevier Ltd. All rights reserved.