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Nodules Less Than 20 mm and Vascular Invasion are Predictors of Survival in Small Hepatocellular Carcinoma

Kikuchi, Luciana O.O. MD*; Paranaguá-Vezozzo, Denise C. MD, PhD*; Chagas, Aline L. MD*; Mello, Evandro S. MD, PhD; Alves, Venancio A.F. MD, PhD; Farias, Alberto Q. MD, PhD*; Pietrobon, Ricardo MD, PhD, MBA; Carrilho, Flair J. MD, PhD*

Journal of Clinical Gastroenterology: February 2009 - Volume 43 - Issue 2 - p 191-195
doi: 10.1097/MCG.0b013e31817ff199

Background The aims of this study were to analyze the overall survival of patients with cirrhosis and small hepatocellular carcinoma (HCC) and identify independent pretreatment predictors of survival in Brazil.

Methods Between 1998 and 2003, 74 patients with cirrhosis and small HCC were evaluated. Predictors of survival were identified using the Kaplan-Meier survival curves and the Cox model.

Results The overall survival rates were 80%, 41%, and 17% at 12, 36, and 60 months, respectively. The mean length of follow-up after HCC diagnosis was 23 months (median 22 mo, range: 1 to 86 mo) for the entire group. Univariate analysis showed that model for endstage liver disease (MELD) score (P=0.016), Child-Pugh classification (P=0.007), α-fetoprotein level (P=0.006), number of nodules (P=0.041), tumor diameter (P=0.009), and vascular invasion (P<0.0001) were significant predictors of survival. Cox regression analysis identified vascular invasion (relative risk=14.60, confidence interval 95%=3.3-64.56, P<0.001) and tumor size >20 mm (relative risk=2.14, confidence interval 95%=1.07-4.2, P=0.030) as independent predictors of decreased survival. Treatment of HCC was related to increased overall survival.

Conclusions Identification of HCC smaller than 20 mm is associated with longer survival. Presence of vascular invasion, even in small tumors, maybe associated with poor prognosis. Treatment of small tumors of up to 20 mm diameter is related to increased survival.

Departments of *Gastroenterology

Pathology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil

Department of Surgery, Center for Excellence in Surgical Outcome, Duke University Medical, Durham, NC

Authors do not have any potential conflicts of interest.

Alvez de Queiroz Family Fund for Research for partial financial support.

Reprints: Luciana O.O. Kikuchi, MD, Department of Gastroenterology, University of Sao Paulo School of Medicine, 255, Dr Enéas C. Aguiar Avenue, Room 9159 CEP 05403-000 Sao Paulo, SP, Brazil (e-mail:

Received for publication March 14, 2008; accepted May 13, 2008

© 2009 Lippincott Williams & Wilkins, Inc.