Background/aims: As surgical morbidity and mortality for hepatocellular carcinoma resection decline, we would like to analyze the possible prognostic factors for small hepatocellular carcinoma after curative resection.
Methodology: A total of 170 patients receiving primary hepatectomies for small hepatocellular carcinoma (< or = 3 cm in diameter) at the National Taiwan University Hospital from December 1987 to February 1997 were enrolled as Group 1. The other 281 patients receiving hepatectomies for hepatocellular carcinoma larger than 3 cm were enrolled as the control group (Group 2). The overall patient and disease-free survival rates were calculated and the possible prognostic factors analyzed.
Results: The 1-, 3-, 5-, and 10-year patient survival rates in Group 1 were 89.6, 73.1, 55.7 and 34.0%, respectively. A safety margin > or = 1 cm (p = 0.0283), single tumor (p = 0.0324), and multiple hepatic resection (p = 0.0239) were factors favorable to patient survival by multivariate risk factor analysis. The disease-free survivals for Group 1 were 75.6, 41.4, 25.9 and 19.2% at 1, 3, 5, and 10 years, respectively. Significant factor for better disease-free survival included only euploid DNA content (p = 0.0026). The patient survival and disease-free survival rates of Group 1 were significantly better than those of Group 2.
Conclusions: We conclude that patients with small hepatocellular carcinoma have better prognosis than those patients with larger tumors. Early detection of hepatocellular carcinoma and its recurrence are crucial for both patient and disease-free survival. The only prognostic factors that can be manipulated are the keeping of adequate safety margin and repeated resection for recurrent hepatocellular carcinoma.