Tumor grade may be used to select patients with multifocal hepatocellular carcinoma for resection

Samantha M. Ruff, Luke D. Rothermel, Laurence P. Diggs, Michael M. Wach, Reed I. Ayabe, Sean P. Martin, David Boulware, Daniel Anaya, Jeremy L. Davis, John E. Mullinax, Jonathan M. Hernandez

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: While resection is a recommended treatment for patients with stage 1 hepatocellular carcinoma (HCC), it remains controversial for multifocal disease. We sought to identify patients with multifocal HCC with survival after resection similar to patients with clinical stage 1 HCC. Methods: The National Cancer Database was queried to identify patients that underwent resection for HCC. Results: In this study, 2990 patients with a single tumor, and 1087 patients with multifocal disease confined to one lobe underwent resection. In the multifocal cohort, patients with clinical stage 3 (HR 1.54, CI 1.31–1.81, p < 0.0001) or 4 (HR 2.27, CI 1.57–3.29, p < 0.0001) disease, and those with moderately-differentiated (HR 1.32, CI 1.06–1.64, p = 0.012) or poorly differentiated/undifferentiated tumors (HR 1.53, CI 1.20–1.95, p = 0.0006) were associated with worse overall survival (OS). There was no difference in OS between patients with well-differentiated clinical stage 2 multifocal HCC and those with all grades of clinical stage 1 HCC (median of 84.8 (CI 66.3–107.2) vs 76.2 months (CI 71.2–81.3), respectively, p = 0.356). Conclusions: Patients with well-differentiated, clinical stage 2 multifocal HCC confined to one lobe experience similar OS following hepatic resection to patients with clinical stage 1 disease. These findings may impact the management of select patients with multifocal HCC.

Original languageEnglish (US)
Pages (from-to)1004-1010
Number of pages7
Issue number7
StatePublished - Jul 2020

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

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