Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
J Cancer Res Clin Oncol. 2011 Apr;137(4):567-75. doi: 10.1007/s00432-010-0909-5. Epub 2010 May 28.
Increasing evidence has suggested that tumor size is one of the independent prognostic factors of patients with hepatocellular carcinoma (HCC). However, the criteria used to determine when HCC should be classified as small remain controversial. Our objective was to evaluate the relationship between the size of HCC and its clinicopathological features.
A retrospective study on 618 patients who underwent partial hepatectomy for solitary HCC was performed. These patients were divided into Groups 1-5 according to the tumor diameter: ≤ 1, 1.1-2, 2.1-3, 3.1-5 and >5 cm, respectively. The clinicopathological variables of the patients in each group were compared statistically.
Except for the microHCC (≤ 1 cm) which differed significantly from the other four groups in the clinicopathological variables, almost no differences existed among HCC ranging from 1 to 3 cm, or HCCs > 3 cm. If ≤ 3 cm was used as the cut-off point for small HCC (SHCC), and >3 cm for large HCC (LHCC), significant differences (P < 0.05-0.01) were observed between SHCC and LHCC in: histological grades I-II (48.0 vs. 19.4 %), capsular invasion (15.4 vs. 36.3%), tumor thrombi (6.9 vs. 23.5%), satellite nodules (12.3 vs. 35.5%), noninvasive growth patterns (69.6 vs. 25.4%), the overall survival (OS, 119.6 ± 34.7 vs. 68.5 ± 6.6 months), and the recurrence-free survival (RFS, 67.0 ± 16.7 vs. 29.5 ± 3.2 months). Multivariate Cox regression analyses show that tumor size >3 cm was one of the independent prognostic factors for both OS and RFS.
The 3 cm cutoff seems to best determine the biological behavior and clinical prognosis of patients undergoing partial hepatectomy for early stage HCC. Overall, HCC smaller than 3 cm in diameter was closely related with a better prognosis which reflected the relatively benign pathobiological features at an early developmental stage. As HCC > 3 cm exhibited a tendency towards more aggressive behavior, we suggest that HCC ≤ 3 cm in diameter should be used as a critical size of SHCC at which curative treatment achieves better long-term survivals.
越来越多的证据表明肿瘤大小是肝癌（HCC）患者的独立预后因素之一。然而，用于确定何时将 HCC 归类为小肿瘤的标准仍存在争议。我们的目的是评估 HCC 大小与其临床病理特征之间的关系。
对 618 例接受部分肝切除术治疗单发 HCC 的患者进行回顾性研究。这些患者根据肿瘤直径分为 5 组：≤1cm、1.1-2cm、2.1-3cm、3.1-5cm 和>5cm。统计比较每组患者的临床病理变量。
除微 HCC（≤1cm）在临床病理变量方面与其他四组有显著差异外，直径 1-3cm 或>3cm 的 HCC 之间几乎没有差异。如果将≤3cm 作为小 HCC（SHCC）的截止点，>3cm 作为大 HCC（LHCC）的截止点，则 SHCC 和 LHCC 之间在以下方面存在显著差异（P<0.05-0.01）：组织学分级 I-II（48.0% vs. 19.4%）、包膜侵犯（15.4% vs. 36.3%）、肿瘤血栓（6.9% vs. 23.5%）、卫星结节（12.3% vs. 35.5%）、非侵袭性生长模式（69.6% vs. 25.4%）、总生存率（OS，119.6±34.7 vs. 68.5±6.6 个月）和无复发生存率（RFS，67.0±16.7 vs. 29.5±3.2 个月）。多因素 Cox 回归分析显示，肿瘤大小>3cm 是 OS 和 RFS 的独立预后因素之一。
3cm 截止似乎最能确定接受部分肝切除术治疗早期 HCC 患者的生物学行为和临床预后。总的来说，直径小于 3cm 的 HCC 与更好的预后密切相关，这反映了在早期发育阶段相对良性的病理生物学特征。由于 HCC>3cm 表现出更具侵袭性的行为，我们建议将直径≤3cm 的 HCC 作为 SHCC 的临界大小，在此大小下，根治性治疗可获得更好的长期生存率。
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