title: Tumor size does not independently affect long-term survival after curative resection of solitary hepatocellular carcinoma without macroscopic vascular invasion.
abstract: OBJECTIVE
  The aim of this study was to investigate the prognostic value of tumor size alone on long-term survival and recurrence after curative resection for solitary hepatocellular carcinoma (HCC) without macroscopic vascular invasion.
  
  
  METHODS
  A single-center cohort of 615 patients with solitary HCC (a single tumor, without macroscopic vascular invasion or distant metastasis) undergoing curative hepatic resection from 2002 to 2010 was retrospectively studied. Using 2.0, 3.0, 4.0, 5.0, 8.0, and 10.0 cm as cut-off values of tumor size, the overall survival (OS) and recurrence-free survival (RFS) rates were compared between the groups of patients with tumor size up to a certain cut-off value and the groups of patients with tumor size above that cut-off value. Thus, multiple comparisons were done. The prognostic factors of OS and RFS were evaluated using univariate and multivariate analyses.
  
  
  RESULTS
  The median tumor size of all HCCs was 4.0 cm (range 0.9-22.0 cm). The in-hospital mortality rate was 1.0 %, and the overall morbidity rate was 22.3 %. The 1-, 3-, and 5-year OS rates were 96.0, 79.8, and 69.9 %, and the corresponding RFS rates were 83.6, 72.7, and 57.2 %, respectively. On univariate analyses, the 1-, 3-, and 5-year OS and RFS rates were significantly different between the individual two groups of patients as divided by the aforementioned different cut-off values of tumor sizes (all p < 0.05). However, when tumor size was put as a continuous variable into multivariate analysis, it was no longer an independent prognostic factor of OS or RFS after curative resection.
  
  
  CONCLUSIONS
  Tumor size did not independently affect long-term survival and recurrence after curative resection of solitary HCC without macroscopic vascular invasion. Therefore, there is no size limit that precludes hepatic resection for solitary HCC, provided the tumor is resectable.
authors.affiliation: Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No.225, Changhai Road, Shanghai, China.
authors.forename: Han
authors.initials: H
authors.lastname: Zhang
authors.forename: Shou-Xin
authors.initials: SX
authors.lastname: Yuan
authors.forename: Shu-Yang
authors.initials: SY
authors.lastname: Dai
authors.forename: Jin-Min
authors.initials: JM
authors.lastname: Zhang
authors.forename: Xing
authors.initials: X
authors.lastname: Huang
authors.forename: Chong-De
authors.initials: CD
authors.lastname: Lu
authors.forename: Jun-Hua
authors.initials: JH
authors.lastname: Lu
authors.forename: Fu-Quan
authors.initials: FQ
authors.lastname: Wu
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
authors.forename: Tian
authors.initials: T
authors.lastname: Yang
authors.forename: Feng
authors.initials: F
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult