Observational Study
Copyright ©The Author(s) 2021.
World J Gastrointest Surg. May 27, 2021; 13(5): 476-492
Published online May 27, 2021. doi: 10.4240/wjgs.v13.i5.476
Table 1 Demographic data (categorical) of hepatocellular carcinoma patients undergoing liver resection, n (%), n = 3985
Variables

Total
S-HCC, < 10 cm
L-HCC, ≥ 10 cm
P value
Number13985 (100)3559 (89)426 (11)
GenderMale3061 (77)2716 (76)345 (81)0.031
Age≤ 209 (< 1)4 (< 1)5 (1)< 0.001
21-40292 (7) 240 (7)52 (12)
41-601668 (42)1478 (42)190 (45)
≥ 612016 (51)1837 (52)179 (42)
DiabetesYes831 (21)764 (21)67 (16)0.006
HypertensionYes1172 (29)1053 (30)119 (28)0.480
HBV surface antigenPositive2074 (52)1849 (52)225 (53)0.740
Anti-HCV antibodyPositive1135 (28)1091 (31)44 (10)< 0.001
Non-HBV non-HCVYes986 (25)815 (23)171 (40)< 0.001
Cigarette smokingYes380 (10)330 (9)50 (12)0.100
Alcohol consumptionYes322 (8)277 (8)45 (11)0.047
Betel nutYes109 (3)93 (3)16 (4)0.170
AJCC 6th (2002-2009)17711577194
Stage I1035 (58)973 (62)62 (32)< 0.001
Stage II347 (20)307 (19)40 (21)
Stage III364 (21)279 (18)85 (44)
Stage IV25 (1)18 (1)7 (4)
AJCC 7th (2010-2015)22141982232
Stage I1064 (48)1031(52)33 (14)< 0.001
Stage II783 (35)717 (36)66 (28)
Stage III341 (15)220 (11)121 (52)
Stage IV26 (1)14 (1)12 (5)
Table 2 Demographic data (continuous) of hepatocellular carcinoma patients undergoing liver resection, n = 3985
Variables
Total
S-HCC, < 10 cm
L-HCC, > 10 cm
P value

Mean ± SD
Mean ± SD
Mean ± SD
Tumor sizecm4.41 ± 3.983.36 ± 2.1413.14 ± 4.95< 0.001
Ageyr58.7 ± 12.459.1 ± 12.155.7 ± 14.3< 0.001
Alpha-fetoproteinng/mL6156.3 ± 600122400.7 ± 1908740531.8 ± 178925< 0.001
Albuming/dL3.8 ± 0.63.8 ± 0.63.5 ± 0.7< 0.001
Alkaline phosphataseU/L97.9 ± 104.490.1 ± 75.6161.1 ± 221.4< 0.001
ASTU/L81.3 ± 158.176.4 ± 140.0121.8 ± 261.2< 0.001
ALTU/L85.1 ± 144.884.2 ± 133.592.2 ± 217.00.290
Bilirubin-directmg/dL0.4 ± 0.80.4 ± 0.80.4 ± 0.60.400
Bilirubin-totalmg/dL1.1 ± 1.31.1 ± 1.41.1 ± 1.00.680
ICG-15%9.7 ± 7.99.9 ± 8.18.0 ± 5.8< 0.001
PTseconds11.8 ± 2.111.7 ± 2.012.0 ± 2.60.019
Table 3 Surgical and oncological outcome of patients with hepatocellular carcinoma, n (%)
S-HCC, < 10 cmL-HCC, ≥ 10 cmP-value
Surgical mortality at 30-d25 (0.7)9 (2.1)0.003
Patient number13559 (100)426 (100)
Follow-up times in d, mean ± SD1733.1 ± 1071.51175.3 ± 1034.2< 0.001
Recurrence status< 0.001
Yes1568 (44.1)256 (60.1)
No1735 (48.7)101 (23.7)
Never disease free256 (7.2)69 (16.2)
Recurrence pattern< 0.001
Local21109 (70.7)131 (51.2)
Regional388 (5.6)10 (3.9)
Combined463 (4.0)36 (14.1)
Distant87 (5.5)47 (18.4)
Death without recurrence221 (14.1)32 (12.5)
Disease free survival in d, median (IQR)1024 (413-1907)329 (121-1244)< 0.001
1-yr DFS rate2585 (78.3)173 (48.5)< 0.001
3-yr DFS rate2037 (61.7)129 (36.1)< 0.001
5-yr DFS rate1828 (55.3)111 (31.1)< 0.001
Final status< 0.001
Alive2424 (68.1)175 (41.1)
Death - liver cause795 (22.3)195 (45.8)
Death - other cause340 (9.6)56 (13.1)
Overall survival (d) [median (IQR)]1579 (871-2455)801.5 (362-1818)< 0.001
1-yr OS rate3354 (94.2)323 (75.8)< 0.001
3-yr OS rate2954 (83.0)227 (53.3)< 0.001
5-yr OS rate2689 (75.6)197 (46.2)< 0.001
Table 4 Analyses of survival outcome with and without IPTW between the two groups: HCC ≥ 10 cm vs < 10 cm
Without IPTW
With IPTW
Unadjusted
Adjusted
Unadjusted
Adjusted
Hazard ratio (95%CI)
P value
Hazard ratio (95%CI)
P value
Hazard ratio (95%CI)
P value
Hazard ratio (95%CI)
P value
Recurrence
Entire cohort2.24 (1.96-2.56)< 0.0011.85 (1.60-2.13)< 0.0011.60 (1.28-2.01)< 0.0011.73 (1.40-2.15)< 0.001
Within stage I1.43 (0.87-2.37)< 0.0011.62 (1.02-2.56)0.042
Within stage II1.64 (1.23-2.20)0.1601.70 (1.28-2.27)< 0.001
Within stage III1.98 (1.61-2.43)0.0012.14 (1.74-2.63)< 0.001
Within stage IV1.46 (0.56-3.83)< 0.0011.93 (0.63-5.91)0.251
All-cause mortality
Entire cohort2.70 (2.36-3.10)< 0.0011.95 (1.68-2.26)< 0.0011.99 (1.59-2.48)< 0.0012.07 (1.70-2.51)< 0.001
Within stage I2.34 (1.49-3.67)< 0.0012.47 (1.64-3.74)< 0.001
Within stage II1.81 (1.22-2.69)0.0031.80 (1.31-2.49)< 0.001
Within stage III1.78 (1.44-2.20)< 0.0011.89 (1.52-2.35)< 0.001
Within stage IV0.71 (0.27-1.86)0.4901.31 (0.58-2.96)0.510
Liver-cause mortality
Entire cohort3.16 (2.70-3.70)< 0.0012.16 (1.82-2.56)< 0.0012.09 (1.61-2.72)< 0.0012.15 (1.73-2.67)< 0.001
Within stage I2.36 (1.31-4.26)0.0042.15 (1.43-3.24)< 0.001
Within stage II1.95 (1.21-3.15)0.0061.88 (1.29-2.72)0.001
Within stage III2.00 (1.58-2.55)< 0.0012.12 (1.67-2.69)< 0.001
Within stage IV0.67 (0.24-1.92)0.4600.96 (0.37-2.48)0.932
Table 5 Comparison of current study with our previous report

Yeh etal[27]: 1st era
Current study: 2nd era
Number of HCC ≥ 10 cm211426
Study period1982-20012002-2015
Study designRetrospectiveInstitutional-based cohort with IPTW
Age in yr47.8 ± 14.355.7 ± 14.3
Gender, male %78%81%
HBV infection, positive81.9%52.8%
HCV infection, positive11.6%10.3%
Size in cm13.9 ± 3.413.14 ± 4.95
Surgical mortality at 30-d4.3%2.1%
1-yr DFS rate32.9%48.5%
3-yr DFS rate18.8%36.1%
5-yr DFS rate12.7%31.1%
1-yr OS rate48.1%75.8%
3-yr OS rate24.0%53.3%
5-yr OS rate16.7%46.2%
Table 6 Analyses of survival outcome with and without inverse-probability of treatment weighting between the two groups (hepatectomy vs transarterial chemoembolization) - TNM and Barcelona Clinic Liver Cancer stage
Without IPTW
With IPTW
Unadjusted
Adjusted
Unadjusted
Adjusted
Hazard ratio (95%CI)
P value
Hazard ratio (95%CI)
P value
Hazard ratio (95%CI)
P value
Hazard ratio (95%CI)
P value
All-cause mortality
Entire cohort0.33 (0.28-0.40)< 0.0010.46 (0.38-0.55)< 0.0010.49 (0.39-0.61)< 0.0010.46 (0.38-0.56)< 0.001
Within stage I0.39 (0.20-0.80)0.0090.37 (0.19-0.73)0.004
Within stage II0.30 (0.16-0.54)< 0.0010.24 (0.13-0.45)< 0.001
Within stage III0.50 (0.41-0.62)< 0.0010.50 (0.40-0.62)< 0.001
Within stage IV0.31 (0.14-0.67)0.0030.30 (0.09-0.93)0.037
Liver-cause mortality
Entire cohort0.32 (0.26-0.39)< 0.0010.45 (0.37-0.56)< 0.0010.48 (0.37-0.61)< 0.0010.46 (0.37-0.56)< 0.001
Within stage I0.33 (0.16-0.71)0.0040.27 (0.12-0.60)0.001
Within stage II0.30 (0.16-0.56)< 0.0010.22 (0.10-0.47)< 0.001
Within stage III0.50 (0.39-0.63)< 0.0010.50 (0.40-0.63)< 0.001
Within stage IV0.30 (0.13-0.70)0.0050.29 (0.09-1.00)0.050
All-cause mortality
Entire cohort0.33 (0.28-0.40)< 0.0010.37 (0.30-0.47)< 0.0010.38 (0.30-0.48)< 0.0010.38 (0.30-0.48)< 0.001
BCLC stage ANANANANA
BCLC stage B0.33 (0.23-0.48)< 0.0010.30 (0.20-0.44)< 0.001
BCLC stage C0.40 (0.30-0.53)< 0.0010.41 (0.31-0.54)< 0.001
BCLC stage DNANANANA
Liver-cause mortality
Entire cohort0.32 (0.26-0.39)< 0.0010.35 (0.27-0.44)< 0.0010.36 (0.28-0.45)<0 .0010.35 (0.28-0.45)< 0.001
BCLC stage ANANANANA
BCLC stage B0.32 (0.21-0.47)< 0.0010.29 (0.19-0.43)< 0.001
BCLC stage C0.37 (0.27-0.49)< 0.0010.38 (0.28-0.51)< 0.001
BCLC stage DNANANANA