Introduction: The present study aimed to evaluate the effect of poor differentiation and tumor size on survival outcome after hepatic resection of hepatocellular carcinoma (HCC). Methods: A total of 1,107 patients who underwent initial and curative hepatic resection for HCC without macroscopic vascular invasion participated in the study. Using the multivariable Cox proportional hazards regression model, we evaluated changes in hazard ratios (HRs) for the association between tumor differentiation and survival based on tumor size. Results: In patients with poorly (Por) differentiated HCCs, the adjusted HRs of reduced overall survival (OS), recurrence-free survival (RFS), early RFS, and early extrahepatic RFS were 1.31 (95% confidence interval [CI]; 1.07–1.59), 1.07 (95% CI 0.89–1.28), 1.31 (95% CI 1.06–1.62), and 1.81 (95% CI 1.03–3.17), respectively. Moreover, based on an analysis of the effect modification of tumor differentiation according to tumor size, Por HCC was found to be associated with a reduced OS (p = 0.033). The HRs of Por HCCs sharply increased in patients with tumors measuring up to 5 cm. The adjusted HRs of reduced OS in patients with Por HCCs measuring #x3c;2, ≥2 and #x3c;5, and ≥5 cm were 1.22 (95% CI 0.69–2.14), 1.33 (95% CI 1.02–1.73), and 1.58 (95% CI 1.04–2.42), respectively. The corresponding adjusted HRs of reduced early RFS were 0.85 (95% CI 0.46–1.57), 1.34 (95% CI 1.01–1.8), and 1.57 (95% CI 1.03–2.39), respectively. The adjusted HRs of reduced early extrahepatic RFS were 1.89 (95% CI 0.83–4.3) in patients with tumors measuring ≥2 and #x3c;5 cm and 2.33 (95% CI 0.98–5.54) in those with tumors measuring ≥5 cm. Conclusions: Por HCC measuring ≥2 cm was associated with early recurrence. Hence, it had negative effects on OS. After surgery, patients with Por HCC measuring ≥5 cm should be cautiously monitored for early extrahepatic recurrence. These findings will help physicians devise treatment strategies for patients with HCC.
Liver Cancer

中文翻译：

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肿瘤分化对肝细胞癌切除术后复发和生存的预后影响取决于肿瘤大小

简介：本研究旨在评估分化差和肿瘤大小对肝细胞癌 (HCC) 肝切除术后生存结果的影响。方法：共有 1,107 名因 HCC 接受初始和治愈性肝切除术且无肉眼可见血管侵犯的患者参与了研究。使用多变量 Cox 比例风险回归模型，我们评估了基于肿瘤大小的肿瘤分化与生存之间关联的风险比 (HR) 变化。结果：在分化差 (Por) 的 HCC 患者中，调整后的总生存期 (OS)、无复发生存期 (RFS)、早期 RFS 和早期肝外 RFS 的 HR 为 1.31 (95% 置信区间 [CI]; 1.07–1.59 )、1.07 (95% CI 0.89–1.28)、1.31 (95% CI 1.06–1.62) 和 1.81 (95% CI 1.03–3.17)。此外，基于根据肿瘤大小对肿瘤分化的影响进行的分析，发现 Por HCC 与 OS 降低有关（p= 0.033)。Por HCCs 的 HR 在肿瘤直径达 5 cm 的患者中急剧增加。在测量为#x3c;2、≥2 和#x3c;5 和 ≥5 cm 的 Por HCC 患者中，OS 降低的调整后 HR 分别为 1.22 (95% CI 0.69–2.14)、1.33 (95% CI 1.02–1.73)、和 1.58 (95% CI 1.04–2.42)，分别。早期 RFS 降低的相应调整后 HR 分别为 0.85（95% CI 0.46–1.57）、1.34（95% CI 1.01–1.8）和 1.57（95% CI 1.03–2.39）。在肿瘤≥2 和#x3c;5 cm 的患者中，早期肝外 RFS 降低的调整后 HR 为 1.89 (95% CI 0.83–4.3)，在肿瘤≥5 cm 的患者中为 2.33 (95% CI 0.98–5.54)。结论：测量≥2 cm 的 Por HCC 与早期复发相关。因此，它对操作系统产生了负面影响。手术后，Por HCC 测量 ≥5 cm 的患者应谨慎监测早期肝外复发。这些发现将有助于医生为 HCC 患者制定治疗策略。
肝癌