Adaptation of hepatectomy for huge hepatocellular carcinoma

Background/Purpose. We retrospectively identified prognostic factors in patients with huge hepatocellular carcinoma (HCC) more than 10 cm in diameter and established a clinical strategy for such patients at our institution. Methods. Three-hundred and twenty patients with HCC underwent hepatectomy. Twenty-nine of them were diagnosed with HCC 10 cm or more in diameter (group L). Two hundred and ninety-one patients were diagnosed with HCC less than 10 cm (group S). The overall and disease-free survival rates in the two groups were compared, and the prognostic factors in group L were analyzed. Results. The overall 3-and 5-year survival rates in group L were 33.6% and 33.6%, and these rates in group S were 61.4% and 45.0%, respectively. The difference between the two groups was significant (P = 0.0048). The disease-free survival rates in group L (3-year, 21.5%; 5-year, 21.5%) were also significantly worse than those in group S (3-year, 37.1%; 5-year, 25.4%; P = 0.0022). Background liver (cirrhosis vs no cirrhosis) (P = 0.0380) and TNM stage according to the Liver Cancer Study Group of Japan (stage II or III vs stage IV; P = 0.0308) were significantly associated with prognosis by multivariate analyses. Conclusions. Hepatic resection is a safe and effective treatment for huge HCC of more than 10 cm in diameter. However, we suggest that cirrhotic patients with huge HCC with the presence of both macrovascular invasion and multiple tumors may not be appropriate candidates for hepatic resection.