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Canadian Journal of Gastroenterology
Volume 25, Issue 9, Pages 485-491
Original Article

Factors Affecting the Prognosis of Small Hepatocellular Carcinoma in Taiwanese Patients Following Hepatic Resection

Chih-Jan Ko,1 Su-Yu Chien,2 Chen-Te Chou,3 Li-Sheng Chen,4 Mei-Ling Chen,5 and Yao-Li Chen1,6

1Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
2Department of Pharmacology, Changhua Christian Hospital, Changhua, Taiwan
3Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
4Laboratory of Biostatistics, Changhua Christian Hospital, Changhua, Taiwan
5Department of Surgical Pathology, Changhua Christian Hospital, Changhua, Taiwan
6College of Medicine, Chung Shan Medical University, Taichung, Taiwan

Received 3 September 2010; Accepted 16 March 2011

Copyright © 2011 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Small hepatocellular carcinoma (HCC) affects millions of individuals worldwide. Surveillance of high-risk patients increases the early detection of small HCC.

OBJECTIVE: To identify prognostic factors affecting the overall survival (OS) and recurrence-free survival (RFS) of patients with small HCC.

METHODS: The present prospective study enrolled 140 Taiwanese patients with stage I or stage II small HCC. Clinical parameters of interest included operation type, tumour size, tumour histology, Child-Pugh class, presence of hepatitis B surface antigen and liver cirrhosis, hepatitis C status, alpha-fetoprotein, total bilirubin and serum albumin levels, and administration of antiviral and salvage therapies.

RESULTS: Tumour size correlated significantly with poorer OS in patients with stage I small HCC (P=0.014); however, patients with stage II small HCC experienced a significantly poorer RFS (P=0.033). OS rates did not differ significantly between patients with stage I and stage II small HCC. Tumour margins, tumour histology and cirrhosis did not significantly affect OS or RFS (P>0.05).

DISCUSSION: Increasing tumour size has generally been associated with poorer prognoses in cases of HCC. The present study verified the relationship between small HCC tumour size and OS; however, a reduction in OS with increasing tumour size was demonstrated for patients with stage I – but not for stage II – small HCC.

CONCLUSION: Patients with stage II small HCC may benefit from aggressive surveillance for tumour recurrence and appropriate salvage treatment. Further studies are needed for additional stratification of stage I patients to identify those at increased risk of death.