High risk of lung metastasis after resection of hepatocellular carcinoma more than 7 cm in diameter

The relationship between the tumor size and organs of recurrence was analyzed to identify a high-risk group for the extrahepatic recurrence of hepatocellular carcinoma (HCC) after resection. A total of 544 patients with HCC underwent primary surgical resection for HCC between 2001 and 2010. Of these, 293 patients had a solitary tumor but no macroscopic vascular invasion. The prognostic factors for the overall survival and relapse-free survival were analyzed among these 293 patients. The recurrent organs and frequency of recurrence were also examined. The analysis of the 293 patients showed that both the overall and relapse-free survival rates of the patients with a large tumor (> 7 cm in diameter) were significantly worse than those of the patients with a tumor < 7 cm. The incidence of lung metastasis was remarkably high in the group of patients with tumors more than 7 cm (24.0 %), in comparison to those with tumors < 7 cm. A multivariate analysis revealed that the tumor size was the only independent risk factor for lung metastasis. The patients with large HCC tumors more than 7 cm in diameter were at high-risk for a poor prognosis due to a high percentage of lung metastasis, even if there was no macroscopic vascular invasion.