Predictors of survival after resection of early hepatocellular carcinoma

OBJECTIVE:: To identify clinicopathologic factors that predict survival following hepatectomy in patients with early hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA:: Although surgical resection of early HCC is thought to be associated with a good outcome, factors predictive of prognosis following resection of these tumors remain ill-defined. METHODS:: The Surveillance, Epidemiology, and End Results database was used to identify patients with histologically confirmed early HCC (≤5 cm and no nodal involvement, metastases, or major vascular invasion) who underwent surgical resection (not ablation or transplantation) between 1988 and 2005. Prognostic factors were evaluated using Kaplan-Meier curves and Cox proportional hazards models. RESULTS:: The study included 788 patients. Median tumor size was 3.2 cm, and 20% of patients had tumors ≥2 cm. Most HCC lesions were solitary (74%) and had no evidence of vascular invasion (82%). Following surgery, overall median and 5-year survival were 45 months and 39%, respectively. After adjusting for demographic factors and histological grade, tumor size >2 cm (hazard ratio [HR]: 1.51), multifocal tumors (HR: 1.51), and vascular invasion (HR: 1.44) remained independent predictors of poor survival (all P < 0.05). Based on these findings, a prognostic scoring system was developed that allotted 1 point each for these factors. Patients with early HCC could be stratified into 3 distinct prognostic groups (median and 5-year survival, respectively): 0 points (70 months, 55%), 1 point (52 months, 42%), and ≥;2 points (24 months, 29%) (P < 0.001). CONCLUSIONS:: Although early HCC is generally associated with a good prognosis, pathologic factors can still be used to stratify patients with respect to survival after resection. These data emphasize the importance of pathologic staging even in small HCC.