Solitary Large Hepatocellular Carcinoma: Staging and Treatment Strategy.

Po-Hong Liu,Cheng-Yuan Hsia,Yun-Hsuan Lee,Teh-Ia Huo,Han-Chieh Lin,Rheun-Chuan Lee,Chia-Yang Hsu,Yi-Hsiang Huang,Chien-Wei Su,Sheng-Nan Lu

doi:10.1371/journal.pone.0155588

Abstract

Background & AimsControversies exist on staging and management of solitary large (>5 cm) hepatocellular carcinoma (HCC). This study aims to evaluate the impact of tumor size on Barcelona Clinic Liver Cancer (BCLC) staging and treatment strategy.MethodsBCLC stage A and B patients were included and re-classified as single tumor 2–5 cm or up to 3 tumors ≤3 cm (group A; n = 657), single tumor >5 cm (group SL; n = 224), and multiple tumors >3 cm (group B; n = 351). Alternatively, 240 and 229 patients with solitary large HCC regardless of tumor stage received surgical resection (SR) and transarterial chemoembolization (TACE), respectively. The propensity score analysis identified 156 pairs of patients from each treatment arm for survival comparison.ResultsThe survival was significantly higher for group A but was comparable between group SL and group B patients. Of patients with solitary large HCC, the 1-, 3- and 5-year survival rates were 88% versus 74%, 76% versus 44%, and 63% versus 35% between SR and TACE group, respectively (p<0.001). When baseline demographics were adjusted in the propensity model, the respective 1-, 3- and 5-year survival rates were 87% versus 79%, 76% versus 46%, and 61% versus 36% (p<0.001). The Cox proportional hazards model identified TACE with a 2.765-fold increased risk of mortality compared with SR (95% confidence interval: 1.853–4.127, p<0.001).ConclusionsPatients with solitary large HCC should be classified at least as intermediate stage HCC. SR provides significantly better survival than TACE for solitary large HCC regardless of tumor stage. Further amendment to the BCLC classification is mandatory.

Highlights

Liver cancer accounts for more than 700,000 deaths each year, and is a major cause of cancerrelated deaths globally.[1]
The Cox proportional hazards model identified transarterial chemoembolization (TACE) with a 2.765-fold increased risk of mortality compared with surgical resection (SR) (95% confidence interval: 1.853–4.127, p
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Summary

Introduction

Liver cancer accounts for more than 700,000 deaths each year, and is a major cause of cancerrelated deaths globally.[1]. Solitary large (single tumor > 5 cm in diameter) HCC presents a unique challenge to clinicians. Current HCC management guidelines recommend curative treatment including surgical resection (SR) and radiofrequency ablation (RFA) for early stage HCC, whereas transarterial chemoembolization (TACE) is offered to patients with intermediate stage tumor.[2, 3, 6] The Barcelona Clinic Liver Cancer (BCLC) classification is the most widely used staging system and is endorsed by the AASLD and EASL guidelines.[2, 3] In the original BCLC classification, resectability, rather than tumor size, was emphasized as an indicator between early and intermediate stage HCC.[7] other reports advocate 5 cm as the cut-off point between early and intermediate stage HCC (Table 1). This study aims to evaluate the impact of tumor size on Barcelona Clinic Liver Cancer (BCLC) staging and treatment strategy

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