Surgical Indications for Huge Hepatocellular Carcinoma

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Hepatocellular carcinoma (HCC) is a major global health concern.
• Surgical resection is a primary curative treatment for HCC.
• Identifying factors that predict outcomes in huge HCC is critical for treatment planning.

Purpose of the Study:

• To retrospectively analyze adverse predictors of survival in patients with huge HCC (diameter >10 cm).
• To identify patients with huge HCC who may not be suitable candidates for hepatic resection.

Main Methods:

• Retrospective analysis of 551 HCC patients who underwent hepatectomy (1992-2019).
• Comparison of clinical features and survival rates between huge HCC (n=92) and large HCC (n=115) groups.
• Multivariate analysis to identify independent prognostic factors in the huge HCC group.

Main Results:

• Overall survival was significantly worse in the huge HCC group compared to the large HCC group (p=0.035).
• Adverse predictors for poor prognosis in huge HCC included liver cirrhosis, multiple intrahepatic metastases (≥4), poor histological grade, and macroscopic portal vein invasion.
• Patients with two or more adverse predictors had significantly worse outcomes.

Conclusions:

• Four adverse predictors of survival were identified for huge HCC.
• Patients with huge HCC and two or more adverse predictors are not appropriate candidates for straightforward hepatic resection.
• These findings aid in optimizing treatment selection for patients with large HCC.