Tumor size predicts the biological behavior and influence of operative modalities in hepatocellular carcinoma

The aim of this study was to evaluate the significance of tumor size as a predictor of a tumor's biological behavior and to determine the optimal corresponding operative modalities.

The present study retrospectively evaluated the clinicopathological characteristics and prognostic outcomes of 278 hepatocellular carcinoma (HCC) patients who underwent liver resection (n = 176) or liver transplantation (n = 102; 92 of them were grafts from a living donor) between 1995 and 2007, based on tumor size.

The incidence of vascular invasion and high-grade histology increased with tumor size. Liver resection and transplantation were comparable in patients with tumors < or = 2cm in size. In 2.1-5 cm sized tumors, transplantation resulted in better overall survival (p = 0.011) and disease-free survival (DFS) (p = 0.001). In 5.1-10 cm sized tumors, liver resection led to insignificantly improved overall survival (99 versus 59 months; p = 0.130), but significantly improved DFS (94 versus 25 months; p = 0.006). In > 10 cm sized tumors, both groups showed similarly poor survival. Lastly, in patients with tumors < 5 cm in size and good hepatic function (Child's A or B), transplantation improved overall survival (p = 0.241) and DFS (p = 0.007) rates to an insignificant degree.

Tumor size can be a predictable surrogate of biological behavior in the preoperative period. When tumor size is 2.1-5 cm, transplantation should be considered first, irrespective of the underlying liver condition. In patients with tumors 5.1-10 cm in size, liver resection is preferred.