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Ann Surg. 2009 May;249(5):799-805. doi: 10.1097/SLA.0b013e3181a38eb5.

Predictors of survival after resection of early hepatocellular carcinoma.

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Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.



To identify clinicopathologic factors that predict survival following hepatectomy in patients with early hepatocellular carcinoma (HCC).


Although surgical resection of early HCC is thought to be associated with a good outcome, factors predictive of prognosis following resection of these tumors remain ill-defined.


The Surveillance, Epidemiology, and End Results database was used to identify patients with histologically confirmed early HCC (< or =5 cm and no nodal involvement, metastases, or major vascular invasion) who underwent surgical resection (not ablation or transplantation) between 1988 and 2005. Prognostic factors were evaluated using Kaplan-Meier curves and Cox proportional hazards models.


The study included 788 patients. Median tumor size was 3.2 cm, and 20% of patients had tumors < or =2 cm. Most HCC lesions were solitary (74%) and had no evidence of vascular invasion (82%). Following surgery, overall median and 5-year survival were 45 months and 39%, respectively. After adjusting for demographic factors and histological grade, tumor size >2 cm (hazard ratio [HR]: 1.51), multifocal tumors (HR: 1.51), and vascular invasion (HR: 1.44) remained independent predictors of poor survival (all P < 0.05). Based on these findings, a prognostic scoring system was developed that allotted 1 point each for these factors. Patients with early HCC could be stratified into 3 distinct prognostic groups (median and 5-year survival, respectively): 0 points (70 months, 55%), 1 point (52 months, 42%), and > or =2 points (24 months, 29%) (P < 0.001).


Although early HCC is generally associated with a good prognosis, pathologic factors can still be used to stratify patients with respect to survival after resection. These data emphasize the importance of pathologic staging even in small HCC.

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