title: Features of massive hepatocellular carcinomas.
abstract: BACKGROUND
  Massive hepatocellular carcinomas (HCCs) are uncommon and poorly characterized.
  
  
  OBJECTIVE
  To characterize a large cohort of HCC patients with massive tumors, with documented baseline characteristics and survival data.
  
  
  METHODS
  Records were examined of a cohort of 344 biopsy-proven and randomly presenting unresectable HCC patients with tumors of at least 10 cm diameter (massive), which were analyzed for their clinical characteristics and survival.
  
  
  RESULTS
  Massive HCC patients were significantly different from others, in having less severe cirrhosis and higher blood platelet counts, α-fetoprotein (AFP), alkaline phosphatase (ALKP), and γ-glutamyl transpeptidase (GGTP) levels. Platelets, ALKP, and GGTP correlated with tumor size. Within massive HCCs, ALKP levels related to tumor number, whereas platelet counts related to tumor size. AFP and GGTP related to neither. All four parameters related to survival. A multivariate Cox proportional hazard model showed that ALKP and AFP were significant for overall survival. Survival of massive tumors was not significantly worse than for other larger tumors.
  
  
  CONCLUSIONS
  Massive HCCs were characterized by high blood platelets, AFP, ALKP, and GGTP levels. AFP levels were important for survival, but did not directly relate to tumor size or number, suggesting that AFP represents some other property of massive HCC biology. Patients with massive HCC should thus be considered for active therapeutic intervention, just as for other sizes of HCC.
authors.affiliation: Departments of aHCC Biology bEpidemiology, IRCCS S. de Bellis, National Institute for Digestive Diseases, Castellana Grotte (BA), Italy.
authors.forename: Brian I
authors.initials: BI
authors.lastname: Carr
authors.forename: Vito
authors.initials: V
authors.lastname: Guerra
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016009:Chi-Square Distribution; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015999:Multivariate Analysis; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000032:analysis; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: C097353:AFP protein, human; D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins; D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase