To investigate the association between tumor size and prognosis of patients with hepatocellular carcinoma (HCC) after hepatectomy.

Clinical data of 172 patients undergoing radical hepatectomy and diagnosed as HCC by pathological examination in the First Affiliated Hospital of Xi'an Jiaotong University between December 2002 and December 2011 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 172 patients, 139 were males and 33 were females; 98 were with age ≤55 years old and 74 were with age >55 years old. The receiver operating characteristic (ROC) curve of the relationship between postoperative survival time and tumor size was drawn, and the cut-off value for tumor size was determined at 5.75 cm. According to the best cut-off value, the patients were divided into the small HCC group (tumor size < 5.75 cm, n=85) and huge HCC group (tumor size≥5.75 cm, n=87). The relationship between tumor size and clinicopathologic parameters was analyzed, and the median survival time, cumulative survival rate and disease free survival rate of two groups were compared. The clinicopathologic parameters were included as the factors influencing the survival and prognosis of patients, and independent risk factor analysis was performed. The relationship between tumor size and clinicopathologic parameters was analyzed using Chi-square test. Kaplan-Meier method and Log-rank test were used for survival and prognosis analysis. Cox proportional hazard model was used for univariate analysis and multivariate analysis.

Tumor size was associated with the preoperative AFP, number of tumors and TNM staging (χ²=13.272, 9.378, 7.311; P<0.05). The median survival time and the median recurrence time for the huge HCC group were 24 months and 9 months respectively and were 39 months and 37 months for the small HCC group. The 1-, 3-, 5-year cumulative survival rate for the huge HCC group were 65.5%, 36.0%, 22.9% respectively and were 89.5%, 76.3%, 72.5% respectively for the small HCC group. The overall survival of the huge HCC group was lower than that of small HCC group (χ²=33.644, P<0.05). The 1-, 3-, 5-year disease free survival rate for the huge HCC group were 44.7%, 25.5%, 21.9% respectively and were 84.8%, 67.8%, 66.3% respectively for the small HCC group. The disease free survival rate of huge HCC group was lower than that of small HCC group (χ²=38.908, P<0.05). Preoperative platelets count (Plt)≥155×10⁹/L, tumor size > 5.75 cm and advanced stage of TNM were the independent risk factors influencing the postoperative prognosis of HCC patients (HR=1.588, 3.066, 2.029; P<0.05).

Tumor size is the independent risk factor influencing the prognosis of HCC patients after hepatectomy. The prognosis of patients with tumor size > 5.75 cm is poor.