Published online Feb 27, 2023. doi: 10.4240/wjgs.v15.i2.273
Peer-review started: October 11, 2022
First decision: November 6, 2022
Revised: November 19, 2022
Accepted: February 1, 2023
Article in press: February 1, 2023
Published online: February 27, 2023
Processing time: 139 Days and 9.5 Hours
There is currently no consensus on the inclusion of tumor size in hepatocellular carcinoma (HCC) staging systems. Furthermore, the size cut-off may vary in systems that incorporate tumor size, and a consensus is warranted for inclusion of size into the staging criteria with cut-off to be determined by multi-center collaborative clinical studies.
Research on long-term survival after resection of giant (≥ 10 cm) and non-giant HCC (< 10 cm) has produced conflicting results.
This study aimed to investigate whether oncological outcomes and safety profiles of resection differ between giant and non-giant HCC.
PubMed, MEDLINE, EMBASE, and Cochrane databases were searched. Studies designed to investigate the outcomes of giant vs non-giant HCC were included. The primary endpoints were overall survival (OS) and disease-free survival (DFS). The secondary endpoints were postoperative complications and mortality rates. All studies were assessed for bias using the Newcastle–Ottawa Scale.
24 retrospective cohort studies involving 23747 patients (giant = 3326; non-giant = 20421) who underwent HCC resection were included. OS was reported in 24 studies, DFS in 17 studies, 30-d mortality rate in 18 studies, postoperative complications in 15 studies, and post-hepatectomy liver failure (PHLF) in six studies. The HR was significantly lower for non-giant HCC in both OS (HR 0.53, 95%CI: 0.50-0.55, P < 0.001) and DFS (HR 0.62, 95%CI: 0.58-0.84, P < 0.001). No significant difference was found for 30-d mortality rate (OR 0.73, 95%CI: 0.50-1.08, P = 0.116), postoperative complications (OR 0.81, 95%CI: 0.62-1.06, P = 0.140), and PHLF (OR 0.81, 95%CI: 0.62-1.06, P = 0.140).
Resection of giant HCC is associated with poorer long-term outcomes. The safety profile of resection was similar in both groups; however, this may have been confounded by reporting bias. HCC staging systems should account for the size differences.
Future prospective studies should investigate different modalities of intervention for giant HCC to determine whether these treatments can provide better quality of life outcomes with low therapy-associated morbidity.