Clinicopathologic features and factors related to survival of patients with small hepatocellular carcinoma after hepatic resection.

Hepatic resection for small hepatocellular carcinomas (HCCs) offers patients a chance of cure but is associated with a significant tumor recurrence rate. We characterized 145 resected small HCCs and defined patients who would most benefit from hepatic resection. A retrospective study was conducted of 485 HCC patients who had undergone curative resection. The clinical features and survival rates of patients with HCCs </= 3 cm (group 1, n = 145) were compared with those of patients with HCCs > 3 cm (group 2, n = 340). Compared with group 2 patients, group 1 had worse liver function, a higher frequency of hepatitis C infection, and a lower alpha-fetoprotein level. The 1-, 3-, and 5-year disease-free survival rates of group 1 were better than those of group 2 (82%, 59%, and 42% vs. 56%, 39%, and 31%, respectively) ( p < 0.001). From the sixth postoperative year onward, the proportions of disease-free survivors were not significantly different between the two groups (32% vs. 31%). By multivariate analysis, factors influencing small-HCC patients' outcomes were tumor centrally located ( p = 0.003), indocyanine green retention rate > 10% ( p = 0.017), and albumin level < 3.7 g/dl ( p = 0.004). A clinical risk scoring system incorporating these factors correlated closely with the patients' outcomes and it may be used to select patients who would most benefit from hepatic resection.