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Timothy M. Pawlik, MD, MPH; Ronnie T. Poon, MD; Eddie K. Abdalla, MD; Daria Zorzi, MD; Iwao Ikai, MD; Steven A. Curley, MD; David M. Nagorney, MD; Jacques Belghiti, MD; Irene Oi-Lin Ng, MD; Yoshio Yamaoka, MD; Gregory Y. Lauwers, MD; Jean-Nicolas Vauthey, MD; for the International Cooperative Study Group on Hepatocellular Carcinoma

Arch Surg. 2005;140:450-458.

Hypothesis  A subset of patients with hepatocellular carcinoma (HCC) with a diameter of 10 cm or larger may benefit from hepatic resection.

Design  Retrospective study of a multi-institutional database.

Setting  Five major hepatobiliary centers.

Patients  We identified 300 patients who underwent hepatic resection for HCC 10 cm or larger.

Main Outcome Measures  Clinical and pathologic data were collected, and prognostic factors were evaluated by univariate and multivariate analyses. Patient survival was stratified according to a clinical scoring system and pathologic T classification.

Results  The perioperative mortality rate was 5%. At a median follow-up of 32 months, the median survival was 20.3 months, and the 5-year actuarial survival rate was 27%. Four clinical factors—-fetoprotein of 1000 ng/mL or higher, multiple tumor nodules, the presence of major vascular invasion, and the presence of severe fibrosis—were significant predictors of poor survival (all P<.05). Patients were assigned a clinical score according to the following risk factors: 1, no factor; 2, one or two factors; or 3, three or four factors. On the basis of the clinical score, patients could be stratified into only 2 distinct prognostic groups: no factor (score of 1) vs 1 or more factors (score of 2 or 3) (P<.001). In contrast, when patients were stratified according to pathologic T classification, 3 distinct groups were identified: T1 vs T2 vs T3 and T4 combined (P<.001). Fifty-six percent of the patients with a clinical score of 2 and 20% of patients with a clinical score of 3 actually had T1 or T2 disease on pathologic examination.

Conclusions  Patients with large HCCs should be considered for liver resection as this treatment is associated with a 5-year survival rate exceeding 25%. Clinical predictors should not be used to exclude patients from surgical resection because these factors do not reliably predict outcome.

Group Information: The authors of this article comprise the International Cooperative Study Group on Hepatocellular Carcinoma.
Author Affiliations: Department of Surgery, University of Texas M. D. Anderson Cancer Center, Houston (Drs Pawlik, Abdalla, Zorzi, Curley, and Vauthey); Departments of Surgery (Dr Poon) and Pathology (Dr Ng), University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China; Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan (Dr Yamaoka); Department of Gastroenterological and General Surgery, Mayo Clinic, Rochester, Minn (Dr Nagorney); Department of Surgery, Beaujon Hospital, Paris, France (Dr Belghiti); and Department of Pathology, Massachusetts General Hospital, Boston (Dr Lauwers).

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