title: Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma.
abstract: OBJECTIVE
  A subset of patients with hepatocellular carcinoma (HCC) with a diameter of 10 cm or larger may benefit from hepatic resection.
  
  
  METHODS
  Retrospective study of a multi-institutional database.
  
  
  METHODS
  Five major hepatobiliary centers.
  
  
  METHODS
  We identified 300 patients who underwent hepatic resection for HCC 10 cm or larger.
  
  
  METHODS
  Clinical and pathologic data were collected, and prognostic factors were evaluated by univariate and multivariate analyses. Patient survival was stratified according to a clinical scoring system and pathologic T classification.
  
  
  RESULTS
  The perioperative mortality rate was 5%. At a median follow-up of 32 months, the median survival was 20.3 months, and the 5-year actuarial survival rate was 27%. Four clinical factors-alpha-fetoprotein of 1000 ng/mL or higher, multiple tumor nodules, the presence of major vascular invasion, and the presence of severe fibrosis-were significant predictors of poor survival (all P<.05). Patients were assigned a clinical score according to the following risk factors: 1, no factor; 2, one or two factors; or 3, three or four factors. On the basis of the clinical score, patients could be stratified into only 2 distinct prognostic groups: no factor (score of 1) vs 1 or more factors (score of 2 or 3) (P<.001). In contrast, when patients were stratified according to pathologic T classification, 3 distinct groups were identified: T1 vs T2 vs T3 and T4 combined (P<.001). Fifty-six percent of the patients with a clinical score of 2 and 20% of patients with a clinical score of 3 actually had T1 or T2 disease on pathologic examination.
  
  
  CONCLUSIONS
  Patients with large HCCs should be considered for liver resection as this treatment is associated with a 5-year survival rate exceeding 25%. Clinical predictors should not be used to exclude patients from surgical resection because these factors do not reliably predict outcome.
authors.affiliation: Department of Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Ronnie T
authors.initials: RT
authors.lastname: Poon
authors.forename: Eddie K
authors.initials: EK
authors.lastname: Abdalla
authors.forename: Daria
authors.initials: D
authors.lastname: Zorzi
authors.forename: Iwao
authors.initials: I
authors.lastname: Ikai
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Irene Oi-Lin
authors.initials: IO
authors.lastname: Ng
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamaoka
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
mesh_terms: D000206:Actuarial Analysis; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins