Predictors of survival after resection of early hepatocellular carcinoma.
OBJECTIVE
To identify clinicopathologic factors that predict survival following hepatectomy in patients with early hepatocellular carcinoma (HCC).


BACKGROUND
Although surgical resection of early HCC is thought to be associated with a good outcome, factors predictive of prognosis following resection of these tumors remain ill-defined.


METHODS
The Surveillance, Epidemiology, and End Results database was used to identify patients with histologically confirmed early HCC (< or =5 cm and no nodal involvement, metastases, or major vascular invasion) who underwent surgical resection (not ablation or transplantation) between 1988 and 2005. Prognostic factors were evaluated using Kaplan-Meier curves and Cox proportional hazards models.


RESULTS
The study included 788 patients. Median tumor size was 3.2 cm, and 20% of patients had tumors < or =2 cm. Most HCC lesions were solitary (74%) and had no evidence of vascular invasion (82%). Following surgery, overall median and 5-year survival were 45 months and 39%, respectively. After adjusting for demographic factors and histological grade, tumor size >2 cm (hazard ratio [HR]: 1.51), multifocal tumors (HR: 1.51), and vascular invasion (HR: 1.44) remained independent predictors of poor survival (all P < 0.05). Based on these findings, a prognostic scoring system was developed that allotted 1 point each for these factors. Patients with early HCC could be stratified into 3 distinct prognostic groups (median and 5-year survival, respectively): 0 points (70 months, 55%), 1 point (52 months, 42%), and > or =2 points (24 months, 29%) (P < 0.001).


CONCLUSIONS
Although early HCC is generally associated with a good prognosis, pathologic factors can still be used to stratify patients with respect to survival after resection. These data emphasize the importance of pathologic staging even in small HCC.
Nathan
Hari
H
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
Schulick
Richard D
RD
Choti
Michael A
MA
Pawlik
Timothy M
TM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis; D014481:United States; D055815:Young Adult