Seven centimeters as an optimal cutoff value for prognosis stratification in large monofocal hepatocellular carcinoma

Purpose Barcelona Clinic Liver Cancer (BCLC) guidelines designate monofocal hepatocellular carcinoma (HCC) > 2 cm as BCLC A, and large monofocal HCC is defined at > 5 cm. We aimed to evaluate the optimal cutoff value for large monofocal HCC based on prognosis stratification. Methods From 2011 to 2018, 3055 patients with newly diagnosed HCC, who were managed in our institution, including 868 patients with monofocal HCC > 2 cm and 330 patients with BCLC B, were enrolled in this retrospective study. Results Monofocal HCC > 5 cm patients had worse overall survival (OS) than monofocal HCC 2–5 cm patients (5-year OS: 54% vs. 57%; p = 0.047), confirmed by multivariate analysis (hazard ratio (HR): 1.492, 95% confidence interval (CI): 1.055–2.110; p = 0.024). Monofocal HCC > 5 cm patients had better OS than BCLC B HCC patients (5-year OS: 54% vs. 25%; p < 0.001), confirmed by multivariate analysis ( HR : 0.670, 95% CI: 0.481–0.934; p = 0.018). Using 7 cm as the monofocal HCC cutoff value resulted in worse OS than monofocal HCC 2–7 cm (5-year OS: 50% vs. 57%; p = 0.02), confirmed by multivariate analysis ( HR : 1.625, 95% CI: 1.039–2.540; p = 0.033). Monofocal HCC > 7 cm patients had better OS than BCLC B patients ( p = 0.006). However, no significant difference was identified in the multivariate analysis ( HR : 0.726; 95% CI: 0.473–1.115; p = 0.144). Conclusions The prognosis of monofocal HCC > 7 cm was similar to that of BCLC B, indicating that 7 cm represents an optimal cutoff value for prognosis stratification in large monofocal HCC.