Analysis of survival in very early hepatocellular carcinoma after resection

GOALS, BACKGROUND: The Barcelona-Clinic-Liver-Cancer staging system recommended liver resection only for patients with "very early stage HCC." Liver transplantation was suggested for patients with "early stage HCC" without associated diseases when liver transplantation is always associated with organ shortage. We hypothesized that patients with early hepatocellular carcinoma (HCC) might have comparable survival rate as that with the very early HCC after the surgical treatment if they were spared from early recurrence (ER) defined as tumor recurrence within 1 year after the curative resection. The aim of this study was to validate this hypothesis and to identify preoperative risk factors for ER in early HCC patients after the surgical resection.

The medical records of 194 patients, who underwent surgical resection of HCC, were retrospectively reviewed. One hundred eighty-two patients with either very early or early HCC were included in the final analysis.

The overall survival (OS) rate of very early HCC was significantly longer than that of early HCC after the surgery. However, if the patients with ER were removed, there was no statistically significant difference in OS rate between very early and early HCC where the 3 years OS rates were 91.3 and 86.1%, respectively (P=0.451). Cox proportional hazard model showed that HCC nodule with hyperattenuation in arterial phase, and which lack encapsulation had a risk of ER.

Early HCC without hyperattenuation on arterial phase and with tumor encapsulation might be expected to have comparable outcome with very early HCC after the surgical resection.