Monofocal hepatocellular carcinoma: How much does size matter?

Area of Science:

• Hepatology
• Oncology
• Surgical Oncology

Background:

• The Barcelona Clinic Liver Cancer (BCLC) staging system classifies monofocal hepatocellular carcinoma (HCC) as early (BCLC A) regardless of size.
• Controversies exist regarding the optimal staging and treatment for large monofocal HCC tumors (>5 cm).

Purpose of the Study:

• To evaluate the appropriate staging and treatment strategies for large (>5 cm) monofocal HCC.
• To compare the outcomes of large early monofocal HCC (LEM-HCC) with small early monofocal HCC (SEM-HCC) and intermediate stage HCC (BCLC B).

Main Methods:

• Retrospective analysis of the Italian Liver Cancer database.
• Inclusion of 924 patients with SEM-HCC (2-5 cm), 163 patients with LEM-HCC (>5 cm), and 1048 patients with BCLC B stage HCC.
• Multivariate analysis to assess overall survival (OS) and treatment impact.

Main Results:

• LEM-HCC patients exhibited significantly worse OS than SEM-HCC patients (31.0 vs 49.0 months; P < .0001).
• The OS difference between LEM-HCC and BCLC B patients was not significant in the multivariate model (P = .89).
• Treatment was the strongest independent predictor of survival, with liver resection providing the highest survival benefit for both SEM-HCC and LEM-HCC patients.

Conclusions:

• Monofocal HCC larger than 5 cm should not be staged as BCLC A; alternative staging (e.g., BCLC AB) is recommended.
• Liver resection, when feasible, remains the preferred treatment for all patients with large monofocal HCC.