期刊
LIVER CANCER
卷 10, 期 5, 页码 461-472出版社
KARGER
DOI: 10.1159/000517992
关键词
Tumor differentiation; Hepatocellular carcinoma; Tumor size; Prognosis
资金
- Health, Labor, and Welfare Policy Research Grants from the Ministry of Health, Labor, and Welfare of Japan [H30Kansei-Shitei-003]
The study found a correlation between poor differentiation and tumor size of hepatocellular carcinoma (HCC) with survival outcomes, indicating that poorly differentiated HCCs were associated with early recurrence in larger tumors.
Introduction: The present study aimed to evaluate the effect of poor differentiation and tumor size on survival outcome after hepatic resection of hepatocellular carcinoma (HCC). Methods: A total of 1,107 patients who underwent initial and curative hepatic resection for HCC without macroscopic vascular invasion participated in the study. Using the multivariable Cox proportional hazards regression model, we evaluated changes in hazard ratios (HRs) for the association between tumor differentiation and survival based on tumor size. Results: In patients with poorly (Por) differentiated HCCs, the adjusted HRs of reduced overall survival (OS), recurrence-free survival (RFS), early RFS, and early extrahepatic RFS were 1.31 (95% confidence interval [CI]; 1.07-1.59), 1.07 (95% CI 0.89-1.28), 1.31 (95% CI 1.06-1.62), and 1.81 (95% CI 1.03-3.17), respectively. Moreover, based on an analysis of the effect modification of tumor differentiation according to tumor size, Por HCC was found to be associated with a reduced OS (p = 0.033). The HRs of Por HCCs sharply increased in patients with tumors measuring up to 5 cm. The adjusted HRs of reduced OS in patients with Por HCCs measuring <2, >= 2 and <5, and >= 5 cm were 1.22 (95% CI 0.69-2.14), 1.33 (95% CI 1.02-1.73), and 1.58 (95% CI 1.04-2.42), respectively. The corresponding adjusted HRs of reduced early RFS were 0.85 (95% CI 0.46-1.57), 1.34 (95% CI 1.01-1.8), and 1.57 (95% CI 1.03-2.39), respectively. The adjusted HRs of reduced early extrahepatic RFS were 1.89 (95% CI 0.83-4.3) in patients with tumors measuring >= 2 and <5 cm and 2.33 (95% CI 0.98-5.54) in those with tumors measuring >= 5 cm. Conclusions: Por HCC measuring >= 2 cm was associated with early recurrence. Hence, it had negative effects on OS. After surgery, patients with Por HCC measuring >= 5 cm should be cautiously monitored for early extrahepatic recurrence. These findings will help physicians devise treatment strategies for patients with HCC.
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