title: Inverse relationship between cirrhosis and massive tumours in hepatocellular carcinoma.
abstract: BACKGROUND
  A subset of patients with hepatocellular carcinoma (HCC) present with massive tumours. It is unknown why certain patients develop these massive tumours, and whether this presentation is specific to the underlying viral aetiology or patient demographics such as gender, race and age.
  
  
  METHODS
  All patients with HCC at Bellevue Hospital Center, New York from 1998 to 2012 were identified and relevant demographic and clinical information was collected. Computed tomography/magnetic resonance imaging (CT/MRI) images were reviewed and the maximal tumour diameter on axial sections was recorded. Cirrhosis was defined histologically or by radiographical criteria. The two cohorts of massive and non-massive HCC were compared.
  
  
  RESULTS
  A total of 361 patients with HCC were identified, of which 58 were categorized as having a massive HCC using a 13 cm size cut-off. Univariate and multivariate analysis demonstrated a significant association of massive HCC with age <40 years; hepatitis B or Asian ethnicity; and a lack of cirrhosis or platelet count >100.
  
  
  CONCLUSIONS
  Massive HCC represents a tumour subtype that is associated with young, chronic hepatitis B carriers with non-cirrhotic livers. The clinical implications of this finding are that patients with massive HCC are typically excellent resection candidates barring the presence of gross vascular invasion or distant metastases.
authors.affiliation: Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA. umut.sarpel@mountsinai.org
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
authors.forename: Diego
authors.initials: D
authors.lastname: Ayo
authors.forename: Iryna
authors.initials: I
authors.lastname: Lobach
authors.forename: Ruliang
authors.initials: R
authors.lastname: Xu
authors.forename: Elliot
authors.initials: E
authors.lastname: Newman
mesh_terms: D000328:Adult; D000367:Age Factors; D044466:Asian People; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016009:Chi-Square Distribution; D005260:Female; D019694:Hepatitis B, Chronic / Q000208:ethnology / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden