Presence of satellites (HR, 2.79; P = 0.003), cirrhosis (HR, 2.3; P = 0.010), and nonanatomic resection (HR, 1.79; P = 0.031) were independently associated with recurrence. Patients with a single HCC ≤2 cm and

platelet count ≥150,000/μL achieved a median survival of 138 months and a 5-year survival rate of 81%, respectively. Conclusion: Resection of HCC ≤2 cm is safe and achieves excellent results in Western centers. Recurrence continues to be a significant problem. Presence of satellites, platelet count, anatomic resection, check details and cirrhosis are associated with outcomes after resection, even among such early tumors. Resection should continue to be considered a primary treatment modality in patients with small HCC and well-preserved liver function. (HEPATOLOGY 2013) See Editorial on Page 1300 Hepatocellular carcinoma

(HCC) ≤2 cm is regarded as a separate and distinct clinical subgroup by both Eastern and Western experts.1, 2 Detection of tumors at such an early stage has traditionally been rare in the West and as a result, clinicians have had to rely on data almost exclusively from the East. However, LY2109761 as a result of the increased awareness of the need for screening in patients with liver disease and validated criteria for accurate noninvasive diagnosis of such small tumors, the number of HCCs being detected at an early stage will likely increase in North America and Europe.3-5 Patients with such early HCC have a good likelihood of cure with resection, transplantation, or ablation.6-11 Although there have been a significant number of recent publications on the indications and outcomes of both transplantation and ablation in the treatment of early HCC, the literature on which the recommendations regarding the role of surgical resection are based is more dated. A review of the data collected by the Liver Cancer Study Group of Japan demonstrated a 5-year survival

rate of 71% for the 1,318 patients with a single HCC ≤2 cm undergoing surgical resection.12 In contrast, examination of the Surveillance, Epidemiology, and End Results Program database identified only 154 patients with HCC ≤2 cm undergoing resection in the United States over an 8-year period with a 5-year survival rate of only 49%.13 Such differing results leave the role of surgical resection for such early tumors unclear. 上海皓元 In addition, such poor results reported by Western series, as well as the lack of well-defined criteria for resection, have led some authors to suggest that radiofrequency ablation may be the treatment of choice for patients with HCC ≤2 cm even when surgical resection is possible.10, 14 The data presented in this study detail the results from two Western centers performing a large volume of HCC resections. It represents the largest Western series to examine the outcomes of patients undergoing resection of a single HCC ≤2 cm. We also provide the results of our exploratory analyses to determine the clinical variables associated with survival and recurrence.