K. R. Vines2, P. Li1, S. Bergstresser2, B. Comeaux1, D. Dubay3, S. Gray1,2, D. Eckhoff1,2, J. White1,2 1University Of Alabama at Birmingham,Department Of Surgery, Division Of Transplantation,Birmingham, Alabama, USA 2University Of Alabama at Birmingham,School Of Medicine,Birmingham, Alabama, USA 3Medical University Of South Carolina,Department Of Surgery, Division Of Transplantation,Charleston, Sc, USA
Introduction: Hepatocellular carcinoma (HCC) is the leading cause of death among patients with cirrhosis and is common in the US and the world, with an approximately 10-15% 5-year survival rate. The tumor size and number are among the main factors affecting patients’ condition and treatment effect. The aim of this study is to investigate the predictive power of tumor number and size on the overall survival of HCC patients.
Methods: We utilized our prospectively collected single-center database to identify a cohort of 436 HCC patients who received cancer treatment other than liver transplant. We reviewed records to analyze tumor numbers, diameter of the largest lesion, or the sum of diameters of the largest three lesions (SDL3), and other tumor characteristics, as well as their survival status. The patients were sub-grouped into 4 categories: single lesion smaller than 5cm, single lesion equal or greater than 5cm, multiple lesions with SDL3<5cm, and multiple lesions with SDL3≥5cm. Kaplan-Meier method was used to compare the overall survival of HCC patients in the 4 groups. Cox regression model was used to calculate the hazard ratio (HR) controlling for other tumor characteristics including major vessel involvement and portal hypertension.
Results: After controlling for major vessel involvement and portal hypertension, smaller lesion size (SDL3 < 5cm vs SDL3 ≥ 5cm, HR=0.74, p=0.0085) or smaller lesion number (single vs multiple, HR=0.75, p=0.0160) indicated better survival. When the SDL3 < 5cm, there was no significant difference of survival between single and multiple lesions (multi vs single, HR=1.05, p=0.7945). In addition, there was no significant survival difference between patients with a single large lesion and patients with multiple smaller lesions (single ≥ 5cm vs multi SDL3<5cm, HR=1.10, p=0.6636). However, patients with multiple large lesions (SDL≥5cm) tended to have the worst survival compared to the other three groups (HR=1.46 vs multiple small lesions, p=0.0671; HR=1.54 vs single small lesion, p=0.0017; HR=1.32 vs single large lesion, p=0.1073).
Conclusion: Our results suggest that both lesion number and size are important in predicting patient survival. Furthermore, patients with multiple lesions may have worse survival than patients with single lesion in the similar or smaller size. Our results may also suggest that the measurement of the diameters of the largest three lesions could be clinically more important than the measurement of the largest lesion only.
