title: Tumor size of hepatocellular carcinoma in noncirrhotic liver: a controversial predictive factor for outcome after resection.
abstract: BACKGROUND
  Hepatocellular carcinoma in noncirrhotic liver (NC-HCC) presents usually with large size, which is seen as a contraindication to liver transplantation (LT) or even resection. The objective of our single-center study was to identify prognostic factors following resection of large NC-HCCs and to subsequently devise a treatment strategy (including LT) in selected patients.
  
  
  METHODS
  From 2000 to 2010, 89 patients who had hepatic resection for NC-HCC (large ≥ 8 cm in 52) were analyzed with regard to pathological findings, postoperative and long-term outcome.
  
  
  RESULTS
  Five patients died postoperatively. After a mean follow-up of 35 ± 30 months, NC-HCC recurred in 36 patients (26/47 survivors in group 8 cm+, 10/37 in group 8 cm-; p = 0.007). Five-year overall (OS) and disease-free survival (DFS) rates were significantly worse for group 8 cm+ (43.4% vs. 89.2% and 39.3% vs. 60.7% for group 8 cm-, p < 0.05). Seven patients underwent re-hepatectomy and/or LT for isolated intrahepatic recurrence, with 5-year DFS of 57.1%. In a multivariate analysis, the factors associated with poor OS and DFS were vascular invasion and tumor size ≥ 8 cm in the overall population and vascular invasion, fibrosis and satellite nodules in group 8 cm+. Adjuvant transarterial chemotherapy was a protective factor in group 8 cm+. In 22 isolated NC-HCC cases with no vascular invasion or fibrosis, tumor size had no impact on five-year DFS (85%).
  
  
  CONCLUSIONS
  Although patients with NC-HCC ≥ 8 cm had a poorer prognosis, the absence of vascular invasion or fibrosis was associated with excellent survival, regardless of the tumor size. In recurrent patients, aggressive treatment (including LT) can be considered.
authors.affiliation: Service de Chirurgie Digestive et Transplantations, Hôpital Huriez, Rue M. Polonovski, CHU, Univ Nord de France, F-59000 Lille, France. stephanie.truant@chru-lille.fr
authors.forename: S
authors.initials: S
authors.lastname: Truant
authors.forename: E
authors.initials: E
authors.lastname: Boleslawski
authors.forename: A
authors.initials: A
authors.lastname: Duhamel
authors.forename: A-F
authors.initials: AF
authors.lastname: Bouras
authors.forename: A
authors.initials: A
authors.lastname: Louvet
authors.forename: C
authors.initials: C
authors.lastname: Febvay
authors.forename: E
authors.initials: E
authors.lastname: Leteurtre
authors.forename: G
authors.initials: G
authors.lastname: Huet
authors.forename: P
authors.initials: P
authors.lastname: Zerbib
authors.forename: S
authors.initials: S
authors.lastname: Dharancy
authors.forename: M
authors.initials: M
authors.lastname: Hebbar
authors.forename: F-R
authors.initials: FR
authors.lastname: Pruvot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009364:Neoplasm Recurrence, Local; D009929:Organ Size; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult