Departments of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu, 225000, China; Department of Hepatobiliary Surgery, The Second Clinical College, Dalian Medical University, Dalian, Liaoning, 116027, China.
Departments of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Rd, Yangzhou, Jiangsu, 225000, China.
Int J Surg. 2020 Aug;80:94-100. doi: 10.1016/j.ijsu.2020.06.018. Epub 2020 Jun 30.
A typical feature of hepatocellular carcinoma (HCC) is growth with metastasis to distant organs, which is associated with poor survival. Whether tumor size can predict distant metastases in HCC remains unclear.
We identified 29,170 HCC patients with or without distant metastases between 2010 and 2016 in the Surveillance, Epidemiology and End Results database. According to an optimal cutoff value of tumor size (58 mm) for predicting distant metastases using Youden's index, patients were categorized into groups of tumor size ≤30 cm, 30-58 mm, and ≥58 mm.
Tumor size had a significantly positive correlation with distant metastases (r = 0.245, P < 0.001). Among patients with distant metastasis, the most common metastasis site was lung (39.3%), followed by bone (30.0%), and brain (2.0%). Incidence of distant metastases in patients with tumor ≥58 mm was 5.7 times (22.8%/4.0%) that of patients with tumors ≤30 mm and 2.9 times (22.8%/7.9%) that of patients with tumors 30-58 mm. Multivariate analyses showed that compared with ≤30 mm, tumor size ≥58 mm was an independent risk predictor of overall distant metastases (OR, 5.200; 95% CI, 4.635-5.834; P<0.001), lung (OR, 6.036; 95% CI, 5.006-7.278; P<0.001); bone (OR, 3.365; 95% CI, 2.781-4.071; P<0.001); and brain metastasis (OR, 1.905; 95% CI, 1.023-3.547; P<0.05).
Tumor size ≥58 mm is significantly associated with HCC distant metastases. In clinical practice, patients with tumors ≥58 mm may benefit from timely identification of distant metastases.
肝细胞癌（HCC）的一个典型特征是生长并转移到远处器官，这与生存不良有关。肿瘤大小是否能预测 HCC 的远处转移尚不清楚。
我们在 2010 年至 2016 年间从监测、流行病学和最终结果数据库中确定了 29170 例伴有或不伴有远处转移的 HCC 患者。根据 Youden 指数预测远处转移的肿瘤大小最佳截断值（58mm），将患者分为肿瘤大小≤30cm、30-58mm 和≥58mm 组。
肿瘤大小与远处转移呈显著正相关（r=0.245，P<0.001）。在远处转移的患者中，最常见的转移部位是肺（39.3%），其次是骨（30.0%）和脑（2.0%）。肿瘤≥58mm 的患者远处转移发生率是肿瘤≤30mm 的患者的 5.7 倍（22.8%/4.0%），是肿瘤 30-58mm 的患者的 2.9 倍（22.8%/7.9%）。多变量分析表明，与肿瘤≤30mm 相比，肿瘤大小≥58mm 是总体远处转移的独立危险因素（OR，5.200；95%CI，4.635-5.834；P<0.001）、肺转移（OR，6.036；95%CI，5.006-7.278；P<0.001）；骨转移（OR，3.365；95%CI，2.781-4.071；P<0.001）和脑转移（OR，1.905；95%CI，1.023-3.547；P<0.05）。
肿瘤大小≥58mm 与 HCC 远处转移显著相关。在临床实践中，肿瘤大小≥58mm 的患者可能受益于及时识别远处转移。
