title: Prognostic determinants for survival after resection/ablation of a large hepatocellular carcinoma.
abstract: BACKGROUND
  Liver resection of large hepatocellular carcinomas (HCC), measuring at least 10 cm remains a controversial debate. Multiple studies on HCCs treated with surgical resection and/or ablation had shown variable results with 5-year survival rates ranging from 0% to 54.0%. The aim of this study was to evaluate the survival of patients with HCCs measuring at least 10 cm and to identify the potential prognostic variables affecting the outcome.
  
  
  METHODS
  Retrospective analysis was performed on the prospectively updated HCC database. A total of 44 patients with tumours measuring 10 cm or more were 'curatively' treated with surgical resection with or without ablation. Patient demographics, clinical, surgical, pathology and survival data were collected and analysed.
  
  
  RESULTS
  Thirty-one patients received surgical resection alone. Thirteen other patients were treated with a combination of surgical resection and ablation. The median follow-up duration was 14.5 months. The overall median survival at 1, 3 and 5 years were 66.4%, 38.1% and 27.8%, respectively. The median time to tumour recurrence was 10.7 months and the 1, 3 and 5-year disease-free survival were 49.6%, 23.9% and 19.1%, respectively. Univariate analysis demonstrated cirrhosis, microvascular invasion, poor tumour differentiation and ethnicity to adversely affect survival. For overall survival, only cirrhosis, poor tumour differentiation and ethnicity were significant on multivariate analysis. Portal vein tumour thrombus, microvascular invasion and ethnicity were identified on univariate analysis to significantly affect disease-free survival.
  
  
  CONCLUSIONS
  Surgical treatment offers good survival to patients with large HCCs (> or = 10 cm). Both cirrhosis and poor tumour differentiation are independent variables prognostic of adverse survival.
authors.affiliation: Department of Surgery, University of New South Wales, St George Hospital, Sydney, NSW, Australia.
authors.forename: Keh M
authors.initials: KM
authors.lastname: Ng
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.forename: Deborah
authors.initials: D
authors.lastname: Black
authors.forename: Francis C K
authors.initials: FC
authors.lastname: Chu
authors.forename: David L
authors.initials: DL
authors.lastname: Morris