The status of compensated cirrhosis might be negatively associated with the tumor size in patients with hepatitis B virus-related hepatocellular carcinoma

Liver cirrhosis has been a well-known risk factor for the development of hepatocellular carcinoma (HCC). However, this view has recently been challenged. This study aimed to investigate the potential association of cirrhosis with hepatitis B virus (HBV)-related HCC. In this study, two independent multicenter clinical cohorts that included 1,431 HCC patients with chronic HBV infection were retrospectively studied. The first cohort consisted of 334 HCC patients undergoing curative resection and cirrhosis, who have been pathologically diagnosed. The second cohort consisted of 1,087 HCC patients, who have been diagnosed for the presence of cirrhosis based on clinical evidence. Patients of each cohort were further divided into different subgroups according to the presence of cirrhosis and the severity of the cirrhosis. In both cohorts, patients with cirrhosis had smaller tumor size compared to those without cirrhosis (P < 0.05) and a relatively lower proportion of large tumor, defined as tumor size > 5 cm in diameter (P < 0.05). Patients with decompensated cirrhosis had the highest rate of vascular invasion and/or extrahepatic metastases compared with compensated cirrhosis and non-cirrhosis (53.0% vs. 24.8% vs. 26.9%, P < 0.001). In the first cohort, globulin (odds ratio [OR] = 1.096, P = 0.001) and vascular invasion (OR = 4.013, P = 0.013) were independent risk predictors of HCC tumor size >5 cm, while cirrhosis stage Laennec 4B/C was a protective factor (OR = 0.372, P = 0.002). Similar results were observed in the second cohort. In conclusion, this study implied that HCC patients with compensated cirrhosis tend to harbor smaller tumor, but severe cirrhosis favors tumor vascular invasion and metastasis.