Efficacy of surgical treatment on different sizes of hepatitis B virus-related hepatocellular carcinoma and prognostic

Purpose: To investigate the efficacy of surgical resection for patients with different sizes of hepatitis B virus (HBV)related hepatocellular carcinoma (HCC), and to analyze the risk factors influencing the prognosis. Methods: The clinical data of a total of 138 patients with HBV-related HCC admitted to and treated in our hospital from June 2012 to June 2014 were retrospectively analyzed, and the patients were divided into small HCC (SHCC) group (tumor diameter <= 5 cm, n=69) and solitary large HCC (SLHCC) group (tumor diameter >5 cm, n=69) based on the size of tumors. The differences in operative methods, operation time, intraoperative blood loss, number of intraoperative blood transfusion, time of portal triad clamping and incidence of complications, as well as postoperative liver function and alpha fetoprotein (AFP) indexes, tumor recurrence and survival conditions were compared between the two groups. Results: Among the 138 HCC patients who underwent hepatectomy, 54 cases had >= 3 resected hepatic segments, and 84 cases had 3 resected hepatic segments. SHCC group exhibited remarkably shorter operation time and notably smaller intraoperative blood loss than SLHCC group. The 1-, 3 and 5-year overall survival rates were 91.3%, 87.0%, 71.0%, 60.9%, 58.0% and 46.4%, respectively, and the 1-, 3and 5-year disease-free survival rates were 71.0%, 63.8%, 47.8%, 44.9%, 37.7% and 30.4%, respectively, in the two groups. The log-rank test showed that the overall survival rate in SHCC group was distinctly higher than that in SLHCC group (p=0.041), and no statistically significant difference in the disease-free survival rate was detected. According to multivariate analysis, HBV deoxyribonucleic acid (DNA) load >= 10(4) U/mL, tumor diameter 5 cm and positive microvascular invasion were independent risk factors for the patient's prognosis (p<0.05). Conclusions: SLHCC has a similar disease-free survival rate to SHCC but a lower overall survival rate than SHCC. HBV DNA load >= 10(4) U/mL, tumor diameter >5 cm and positive microvascular invasion are independent risk factors for the patient's prognosis.