title: Importance of tumor size as a prognostic factor after partial liver resection for solitary hepatocellular carcinoma: Implications on the current AJCC staging system.
abstract: BACKGROUND
  Presently, the impact of tumors size as a prognostic factor after curative liver resection (LR) for solitary hepatocellular carcinoma (HCC) remains controversial. This study was performed to determine the prognostic factors of patients undergoing LR for solitary HCC with special emphasis on the importance of tumor size.
  
  
  METHODS
  Between 2000 and 2013, 560 patients underwent curative LR for solitary primary HCC which met the study criteria.
  
  
  RESULTS
  One-hundred and seventy-eight patients underwent major hepatectomies and the overall in-hospital mortality was 2.0%. There were 282 patients (50.4%) with liver cirrhosis. The 5-year overall survival (OS) was 64% and recurrence free survival (RFS) was 50%, respectively. Multivariate analyses demonstrated that cirrhosis, microvascular invasion and size were independent predictors of RFS and cirrhosis, microvascular invasion and age were independent prognostic factors of OS. Subset analysis demonstrated that tumor size was a prognostic factor for solitary HCC with microvascular invasion (AJCC T2) but not solitary HCC without microvascular invasion (AJCC T1).
  
  
  CONCLUSIONS
  Size, microvascular invasion, and cirrhosis are independent prognostic factors of RFS for solitary HCC after LR. Tumor size is an important prognostic factor in T2 but not T1 solitary tumors. These findings suggest that the current AJCC TNM staging system may need to be revised.
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.|Duke-NUS Graduate Medical School, Singapore, Singapore.
authors.forename: Brian K P
authors.initials: BK
authors.lastname: Goh
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: Jin-Yao
authors.initials: JY
authors.lastname: Teo
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: Chung-Yip
authors.initials: CY
authors.lastname: Chan
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: Ser-Yee
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: Premaraj
authors.initials: P
authors.lastname: Jeyaraj
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: Peng-Chung
authors.initials: PC
authors.lastname: Cheow
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.|Duke-NUS Graduate Medical School, Singapore, Singapore.|Department of Surgical Oncology, National Cancer Centre, Singapore, Singapore.
authors.forename: Pierce K H
authors.initials: PK
authors.lastname: Chow
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.|Duke-NUS Graduate Medical School, Singapore, Singapore.
authors.forename: London L P J
authors.initials: LL
authors.lastname: Ooi
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: Alexander Y F
authors.initials: AY
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery* / Q000821:virology; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
keywords: American Joint Committee for Cancer; TNM; hepatocellular carcinoma; prognosis; resection; solitary; staging; survival