Long-term survival of patients undergoing liver resection for very large hepatocellular carcinomas

BackgroundThis study aimed to assess long-term survival after liver resection for huge hepatocellular carcinoma (HCC). MethodsPatients with stage I-III HCC who underwent hepatectomy from 2002 to 2010 were identified retrospectively from prospective national databases and followed until December 2012. Patients were assigned into four groups according to tumour size: less than 30cm (small), 30-49cm (medium), 50-100cm (large) and over 100cm (huge). The primary endpoint was overall survival. The Kaplan-Meier method and Cox proportional hazards model were used for survival analysis. ResultsA total of 11079 patients with HCC (mean(s.d.) age 597 (120) years) were eligible for this study. Median follow-up was 725months. Patients with huge HCC had the worst prognosis; overall survival rates for patients with small, medium, large and huge HCC were 720, 621, 508 and 350 per cent respectively at 5 years, and 526, 418, 358 and less than 200 per cent at 10 years (P < 0001). Multivariable analysis showed that tumour size affected long-term survival (hazard ratio (HR) 131, 155 and 238 for medium, large and huge HCC respectively versus small HCC). Prognostic factors for huge HCC were surgical margin larger than 02cm (HR 070; P = 0025), poor differentiation (HR 134; P = 0004), multiple tumours (HR 164; P<0001), vascular invasion (HR 152; P = 0008), cirrhosis (HR 137; P = 0013) and the use of nucleoside analogues (HR 069; P = 0004). ConclusionHuge HCCs have a worse prognosis than smaller HCCs after liver resection. A wide resection margin and antiviral therapy with nucleoside analogues may be associated with favourable long-term survival. Bigger not necessarily better