Huge hepatocellular carcinoma greater than 10 cm in diameter worsens prognosis by causing distant recurrence after curative resection

Background and Objectives This study aimed to evaluate the impact of huge (≥10 cm) hepatocellular carcinoma (HCC) to the recurrence pattern and the prognosis after hepatectomy. Methods 574 patients who underwent hepatectomy by 17 surgeons (Open 536 and Laparoscopic 38) for HCC without major vascular invasion from 1990 to 2013 at single institute were retrospectively analyzed. Results Huge tumor, age, HCV, multiple tumors and microscopic portal invasion are independent risk factors for overall survival (OS), and huge tumor, ICGR15 ≥16%, multiple tumors, moderate/poor histology, microscopic portal invasion and a positive pathological margin are risk factors for relapse‐free survival (RFS). The 5‐year OS and RFS of patients with huge HCC (n = 53) (42.9 and 14.2%) were significantly worse than those of patients with HCC <10 cm (n = 521) (71.3 and 33.1%). Huge tumor is an independent risk factor for initial extra‐hepatic recurrence (Hazard ratio 7.86, P < 0.0001). The 5‐year OS of patients with initial extra‐hepatic recurrence (n = 55) was significantly worse than patients with intra‐hepatic recurrence (n = 338) (16.8 vs. 50.5%). Conclusions Huge HCC (≥10 cm) is an independent risk factor due to a high risk for initial extra‐hepatic recurrence. Future systemic adjuvant therapy is needed for these patients. J. Surg. Oncol. 2017;115:324–329 . © 2016 Wiley Periodicals, Inc.