Clinical significance of early hepatocellular carcinoma

Early hepatocellular carcinoma (HCC) is defined as a well-differentiated cancer containing Glisson's triad, but it remains unknown whether this lesion is curable by surgery. We studied 70 patients who had a single HCC smaller than 2 cm in diameter (Stage T1) and who underwent curative hepatectomy and long-term follow-up. Based on our typing system, the tumors were assigned as early HCC (n=15), overt HCC (n=52), and non-HCC tumor (n=3). The rate of microscopic regional spread was lower in early HCCs than in overt HCCs (7% vs. 42%; P=.01). After a median follow-up of 6.3 years, both overall survival and recurrence-free survival in the early HCC group were significantly better than those in the overt HCC group (P=.01; P=.001, respectively): the 5-year rates of overall survival were 93% and 54% and those of recurrence-free survival were 47% and 16%, respectively. The early HCC group was at a lower risk of recurrence (relative risk, 0.31; 95% confidence interval, 0.15-0.65; P=.002) and death (0.26; 0.09-0.73; P=.01) than was the overt HCC group. Early HCC is a distinct clinical entity with a high rate of surgical cure.