Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
J Gastroenterol Hepatol. 2011 May;26(5):851-7. doi: 10.1111/j.1440-1746.2010.06595.x.
The widespread use of screening programs has resulted in an increase in detection of small hepatocellular carcinoma (HCC). Surgical resection generally leads to favorable outcomes in this group of patients; however, the prognostic significance of tumor size and the optimal cutoff point in resected specimens of small HCC have not been well defined. The aim of current study is to evaluate the prognostic significance of tumor size in small resected HCC.
Patients who underwent surgical resection for small HCC at the Changhua Christian Hospital during January 2001 to June 2007 were enrolled. Small HCC was defined as a single HCC nodule with maximum diameter ≤ 5 cm. Cox regression hazard ratios for cancer-specific death were calculated to survey the prognostic significance of tumor size. We then determined the optimal cut-point for tumor size that could be used to stratify patients into 5-year disease-free survival (DFS) and cancer-specific survival (CSS) groups.
A total of 140 patients who underwent resection of small HCC were enrolled. The mean tumor size was 2.9 cm (range 0.9-5.0) and the mean follow-up period was 43.4 months. The 5-year DFS and CSS rates were 46.6% and 81.6%, respectively. Cox regression analysis revealed that tumor size (hazard ratio = 2.973, 95% confidence interval: 1.073-8.239, P = 0.036) was an independent prognostic factor. Our analysis showed that a tumor size of 3 cm was the cut-point that could dichotomize patients into statistically different 5-year DFS and CSS risk groups.
Tumor size is an independent prognostic factor in resected small HCC and the prognostic significance of tumor size may vary according to different cut-off points.
筛查计划的广泛应用导致小肝细胞癌（HCC）的检出率增加。手术切除通常可使这组患者获得良好的结果；然而，肿瘤大小的预后意义以及小 HCC 切除标本的最佳截止点尚未得到很好的定义。本研究旨在评估肿瘤大小在小 HCC 切除中的预后意义。
回顾性分析 2001 年 1 月至 2007 年 6 月在彰化基督教医院接受手术切除的小 HCC 患者。小 HCC 定义为单个 HCC 结节，最大直径≤5cm。使用 Cox 回归风险比评估肿瘤大小对癌症特异性死亡的预后意义。然后确定肿瘤大小的最佳截止点，可将患者分为 5 年无病生存率（DFS）和癌症特异性生存率（CSS）组。
共纳入 140 例接受小 HCC 切除术的患者。肿瘤平均大小为 2.9cm（范围 0.9-5.0），平均随访时间为 43.4 个月。5 年 DFS 和 CSS 率分别为 46.6%和 81.6%。Cox 回归分析显示肿瘤大小（风险比=2.973，95%置信区间：1.073-8.239，P=0.036）是独立的预后因素。分析表明，肿瘤大小 3cm 是将患者分为统计学上不同的 5 年 DFS 和 CSS 风险组的截止点。
肿瘤大小是小 HCC 切除的独立预后因素，肿瘤大小的预后意义可能因不同的截止点而有所不同。
