Tumor size as a prognostic factor in resected small hepatocellular carcinoma: A controversy revisited

Background and Aim: The widespread use of screening programs has resulted in an increase in detection of small hepatocellular carcinoma (HCC). Surgical resection generally leads to favorable outcomes in this group of patients; however, the prognostic significance of tumor size and the optimal cutoff point in resected specimens of small HCC have not been well defined. The aim of current study is to evaluate the prognostic significance of tumor size in small resected HCC. Methods: Patients who underwent surgical resection for small HCC at the Changhua Christian Hospital during January 2001 to June 2007 were enrolled. Small HCC was defined as a single HCC nodule with maximum diameter < 5 cm. Cox regression hazard ratios for cancer-specific death were calculated to survey the prognostic significance of tumor size. We then determined the optimal cut-point for tumor size that could be used to stratify patients into 5-year disease-free survival (DFS) and cancer-specific survival (CSS) groups. Results: A total of 140 patients who underwent resection of small HCC were enrolled. The mean tumor size was 2.9 cm (range 0.9-5.0) and the mean follow-up period was 43.4 months. The 5-year DFS and CSS rates were 46.6% and 81.6%, respectively. Cox regression analysis revealed that tumor size (hazard ratio = 2.973, 95% confidence interval: 1.073-8.239, P = 0.036) was an independent prognostic factor. Our analysis showed that a tumor size of 3 cm was the cut-point that could dichotomize patients into statistically different 5-year DFS and CSS risk groups. Conclusions: Tumor size is an independent prognostic factor in resected small HCC and the prognostic significance of tumor size may vary according to different cut-off points.