Surgery for large primary liver cancer more than 10 cm in diameter

Large primary liver cancer (PLC) more than 10 cm in diameter is not infrequently encountered in clinical practice. This study evaluated the clinicopathological features and long-term results after surgery for large PLC.

Comparison of clinicopathological data between patients with PLC ≥10 cm (n=1,227) and PLC <10 cm (n=2,349) during the same period.

In comparison with patients with PLC <10 cm, patients with PLC ≥10 cm were significantly younger (P<0.01), had a lower incidence of asymptomatic tumors (9.1% vs 39.5%, P<0.001), higher α-fetoprotein levels ( >400 ng/ml, 78.3% vs 49.2%, P<0.001), higher γ-glutamyl transpeptidase levels ( >6U, 87.7% vs 70.5%, P<0.001), a lower incidence of a history of hepatitis (45.0% vs 61.4%, P<0.001) and associated macronodular cirrhosis (cirrhotic nodules ≥0.3 cm, 59.8% vs 66.6%, P<0.001), poor differentiation of tumor cells (Edmondson grade 3–4, 24.3% vs 19.7%, P<0.01), a lower percentage of single nodule tumors (59.9% vs 75.4%, P<0.001) and well-encapsulated tumors (28.5% vs 62.1%, P<0.001), a higher proportion of tumor emboli in the portal vein (20.5% vs 9.0%, P<0.001), a lower resection rate (50.6% vs 86.8%, P<0.001), a lower curative resection rate (54.8% vs 78.3%, P<0.001), a higher operative mortality rate (4.5% vs 2.3%, P<0.001), and less local resection (52.5% vs 80.2%, P<0.001). The 5- and 10-year survival rates after resection were 26.2% and 17.5%, respectively, for patients with PLC ≥10 cm (n=621), and 54.3% and 39.5%, respectively, for patients with PLC <10 cm (n=2039) (P<0.01).

Large PLC had specific clinicopathological features. Surgery is the first choice of treatment. In selected patients, resection is safe and offers the chance of long-term survival. Large PLC does not exclude the possibility of cure.