Clinicopathological Features and Surgical Results of Hepatocellular Carcinoma under 2 cm in Diameter

Kazuaki Nakanishi, Toshiya Kamiyama, Takahito Nakagawa, Kazuhito Uemura, Hideki Yokoo, Hirofumi Kamachi, Michiaki Matushita and Satoru Todo

Department of General Surgery, Graduate School of Medicine, Hokkaido University

Purpose: We evaluated the clinicopathological features of hepatocellular carcinoma (HCC) less than or equal to 2 cm in diameter, and clarified which tumors should be resected anatomically to improve prognosis. Patients and methods:Of 508 HCC cases under going hepatectomy from 1990 to 2003, 63 less than or equal to 2 cm in maximum diameter were studied. We evaluated clinicopathological features, the effectiveness of anatomical resection, and recurrence-free survival, classified by gross appearance or tumor size. We also evaluated univariate and multivariate analysis of recurrence. Results: Small nodular type with indistinct margins (Type 0) accounted for 11.1%, simple nodular type (Type 1) for 63.5%, simple nodular type with extranodular growth (Type 2) for 19.0%, and confluent multinodular type (Type 3) for 6.3%. In cases of Type 2+3 or more than 1.5cm , the number of portal vein invasions and intrahepatic metastasis increased, while the proportion of well-differentiated HCC in these cases decreased. Disease-free survival was significantly better in anatomical resection (n=24) than in nonanatomical resection (n=39). In cases of Type 2+3 or more than 1.5 cm, disease-free survival was also significantly better in anatomical resection. Anatomical resection, preoperative platelet counts of >120,000/mm³, and nonportal vein invasion were significantly better prognostic factors in recurrence-free survival according to univariate analysis, and anatomical resection and nonportal vein invasion were also significant according to multivariate analysis. Conclusion: Clinicopatholigic variation was wide even in HCC under 2 cm. Biological malignant potential increased in cases of Type 2+3 or more than 1.5 cm, in which case anatomical resection is effective.

Key words
hepatocellular carcinoma, clinicopathological feature, gross appearance, anatomical resection, recurrence-free survival

Reprint requests
Kazuaki Nakanishi Department of General Surgery, Graduate School of Medicine, Hokkaido University
N15-W7 Kita-ku, Sapporo, 060-8638 JAPAN

Accepted
February 22, 2006

To read the PDF file you will need Abobe Reader installed on your computer.