title: Factors affecting prognosis of small hepatocellular carcinoma in Taiwanese patients following hepatic resection.
abstract: BACKGROUND
  Small hepatocellular carcinoma (HCC) affects millions of individuals worldwide. Surveillance of high-risk patients increases the early detection of small HCC.
  
  
  OBJECTIVE
  To identify prognostic factors affecting the overall survival (OS) and recurrence-free survival (RFS) of patients with small HCC.
  
  
  METHODS
  The present prospective study enrolled 140 Taiwanese patients with stage I or stage II small HCC. Clinical parameters of interest included operation type, tumour size, tumour histology, Child- Pugh class, presence of hepatitis B surface antigen and liver cirrhosis, hepatitis C status, alpha-fetoprotein, total bilirubin and serum albumin levels, and administration of antiviral and salvage therapies.
  
  
  RESULTS
  Tumour size correlated significantly with poorer OS in patients with stage I small HCC (P=0.014); however, patients with stage II small HCC experienced a significantly poorer RFS (P=0.033). OS rates did not differ significantly between patients with stage I and stage II small HCC. Tumour margins, tumour histology and cirrhosis did not significantly affect OS or RFS (P>0.05).
  
  
  CONCLUSIONS
  Increasing tumour size has generally been associated with poorer prognoses in cases of HCC. The present study verified the relationship between small HCC tumour size and OS; however, a reduction in OS with increasing tumour size was demonstrated for patients with stage I - but not for stage II - small HCC.
  
  
  CONCLUSIONS
  Patients with stage II small HCC may benefit from aggressive surveillance for tumour recurrence and appropriate salvage treatment. Further studies are needed for additional stratification of stage I patients to identify those at increased risk of death.
authors.affiliation: Department of General Surgery, Changhua Christian Hospital, Taiwan.
authors.forename: Chih-Jan
authors.initials: CJ
authors.lastname: Ko
authors.forename: Su-Yu
authors.initials: SY
authors.lastname: Chien
authors.forename: Chen-Te
authors.initials: CT
authors.lastname: Chou
authors.forename: Li-Sheng
authors.initials: LS
authors.lastname: Chen
authors.forename: Mei-Ling
authors.initials: ML
authors.lastname: Chen
authors.forename: Yao-Li
authors.initials: YL
authors.lastname: Chen
mesh_terms: D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012709:Serum Albumin / Q000378:metabolism; D013624:Taiwan
chemical_list: D006514:Hepatitis B Surface Antigens; D012709:Serum Albumin