Selection of patients with solitary hepatocellular carcinoma for hepatic resection: reassessment of a 5-cm tumor size cut-off

This study compared the efficacy of hepatic resection in patients with solitary hepatocellular carcinoma (HCC) with a tumor diameter > 5 cm or <= 5 cm. A consecutive sample of 386 patients with solitary HCC who were treated by initial resection was divided into those with tumor diameter > 5 cm (n = 203) and those with tumor diameter <= 5 cm (n = 183). A comprehensive literature search of relevant databases was also conducted to assess available evidence on 5 cm as a cut-off point for staging single HCC. Hospital mortality was similar between patients with solitary HCC > 5 cm and those with <= 5 cm, but patients with solitary HCC > 5 cm showed significantly higher morbidity and lower overall survival (both P < 0.05). Meta-analysis of the results of our cohort study with results of 9 studies in the literature (corresponding to 6,008 patients) showed that patients with solitary HCC > 5 cm had significantly worse overall survival than those with <= 5 cm. Therefore, our cohort analysis and literature review suggest that 5 cm is a reliable cut-off point for staging solitary HCC and selecting patients for resection.