Background/aims: The aim of this study was to evaluate the significance of tumor size as a predictor of a tumor's biological behavior and to determine the optimal corresponding operative modalities.
Methodology: The present study retrospectively evaluated the clinicopathological characteristics and prognostic outcomes of 278 hepatocellular carcinoma (HCC) patients who underwent liver resection (n = 176) or liver transplantation (n = 102; 92 of them were grafts from a living donor) between 1995 and 2007, based on tumor size.
Results: The incidence of vascular invasion and high-grade histology increased with tumor size. Liver resection and transplantation were comparable in patients with tumors < or = 2cm in size. In 2.1-5 cm sized tumors, transplantation resulted in better overall survival (p = 0.011) and disease-free survival (DFS) (p = 0.001). In 5.1-10 cm sized tumors, liver resection led to insignificantly improved overall survival (99 versus 59 months; p = 0.130), but significantly improved DFS (94 versus 25 months; p = 0.006). In > 10 cm sized tumors, both groups showed similarly poor survival. Lastly, in patients with tumors < 5 cm in size and good hepatic function (Child's A or B), transplantation improved overall survival (p = 0.241) and DFS (p = 0.007) rates to an insignificant degree.
Conclusions: Tumor size can be a predictable surrogate of biological behavior in the preoperative period. When tumor size is 2.1-5 cm, transplantation should be considered first, irrespective of the underlying liver condition. In patients with tumors 5.1-10 cm in size, liver resection is preferred.