Comparable Long-Term Survival After Curative Hepatectomy for Solitary Large (5–10 cm) versus Giant (≥10 cm) Hepatocellular Carcinoma: A Retrospective Study

Purpose: This study aims to compare long-term oncological outcomes after curative hepatectomy in patients with solitary large versus giant HCC. Patients and Methods: This dual-center study included 281 patients with solitary HCC ≥ 5 cm undergoing R0 hepatectomy, stratified into large (5– 10 cm) and giant (≥ 10 cm) cohorts. 1:1 PSM matched potential confounding variables. Primary endpoint was recurrence-free survival (RFS), analyzed through Kaplan-Meier methods with Log rank testing. Results: At baseline, giant HCC (n=90) patients exhibited significantly higher rates of AFP ≥ 200 ng/mL, major hepatectomy, and intraoperative transfusion compared to large HCC (n=191) cohort. After PSM, 82 patients were allocated to each group, with all baseline characteristics well-balanced. The RFS analysis revealed comparable outcomes between large and giant HCC groups: pre-PSM median RFS, 29.6 vs 26.5 months (HR 0.864, 95% CI 0.615– 1.214, P =0.398); post-PSM median RFS, 21.1 vs 26.5 months (HR 1.128, 95% CI 0.756– 1.681, P =0.555). Median overall survival (OS) was not reached in either group. Conclusion: Patients with solitary giant HCC amenable to upfront curative hepatectomy achieved similar RFS compared to large HCC after surgery, tumor biological characteristics (AFP levels and MVI status) are the primary determinants of postoperative prognosis in HCC patients.