title: Nodules less than 20 mm and vascular invasion are predictors of survival in small hepatocellular carcinoma.
abstract: BACKGROUND
  The aims of this study were to analyze the overall survival of patients with cirrhosis and small hepatocellular carcinoma (HCC) and identify independent pretreatment predictors of survival in Brazil.
  
  
  METHODS
  Between 1998 and 2003, 74 patients with cirrhosis and small HCC were evaluated. Predictors of survival were identified using the Kaplan-Meier survival curves and the Cox model.
  
  
  RESULTS
  The overall survival rates were 80%, 41%, and 17% at 12, 36, and 60 months, respectively. The mean length of follow-up after HCC diagnosis was 23 months (median 22 mo, range: 1 to 86 mo) for the entire group. Univariate analysis showed that model for endstage liver disease (MELD) score (P=0.016), Child-Pugh classification (P=0.007), alpha-fetoprotein level (P=0.006), number of nodules (P=0.041), tumor diameter (P=0.009), and vascular invasion (P<0.0001) were significant predictors of survival. Cox regression analysis identified vascular invasion (relative risk=14.60, confidence interval 95%=3.3-64.56, P<0.001) and tumor size >20 mm (relative risk=2.14, confidence interval 95%=1.07-4.2, P=0.030) as independent predictors of decreased survival. Treatment of HCC was related to increased overall survival.
  
  
  CONCLUSIONS
  Identification of HCC smaller than 20 mm is associated with longer survival. Presence of vascular invasion, even in small tumors, maybe associated with poor prognosis. Treatment of small tumors of up to 20 mm diameter is related to increased survival.
authors.affiliation: Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil. lucianakikuchi29@gmail.com
authors.forename: Luciana O O
authors.initials: LO
authors.lastname: Kikuchi
authors.forename: Denise C
authors.initials: DC
authors.lastname: Paranaguá-Vezozzo
authors.forename: Aline L
authors.initials: AL
authors.lastname: Chagas
authors.forename: Evandro S
authors.initials: ES
authors.lastname: Mello
authors.forename: Venancio A F
authors.initials: VA
authors.lastname: Alves
authors.forename: Alberto Q
authors.initials: AQ
authors.lastname: Farias
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Flair J
authors.initials: FJ
authors.lastname: Carrilho
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000401:mortality* / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015996:Survival Rate; D019043:Vascular Neoplasms / Q000473:pathology*