Natural history of small untreated hepatocellular carcinoma in cirrhosis: a multivariate analysis of prognostic factors of tumor growth rate and patient survival

Hepatology. 1992 Jul;16(1):132-7. doi: 10.1002/hep.1840160122.


We analyzed the growth pattern of tumor masses and the survival of 39 asymptomatic Italian patients with a total of 59 small (less than or equal to 5 cm in diameter) hepatocellular carcinomas arising from cirrhosis. The total length of the observation period ranged from 90 to 962 days, with an average of 364 +/- 229 (mean +/- S.D.). Doubling time ranged from 27.2 to 605.6 days (mean +/- S.D., 204.2 +/- 135; median = 171.6 days). Three different growth patterns were recognized: (a) tumors with no or very slow initial growth pattern (doubling time greater than 200 days), 10 cases (37%); (b) tumors with declining growth rate over time, 9 cases (33.4%); and (c) tumors with almost constant growth rate, 8 cases (29.6%). Using the stepwise discriminant analysis, we found a score based on albumin, alcohol intake, number of nodules, echo pattern and histological type that allowed a correct prediction of short doubling time (less than or equal to 150 days) in 55.6%, medium doubling time (151 to 300 days) in 60% and long doubling time (greater than 300 days) in 100% of cases. The estimated survival rate of the 39 patients, calculated by the Kaplan-Meier method was 81% at 1 yr, 55.7% at 2 yr and 21% at 3 yr. Stepwise discriminant analysis showed that a score based on sex, HBsAg status, alcohol consumption, ascites, gamma-glutamyltranspeptidase, prothrombin time, Child-Pugh class and all the sonographical parameters could predict 2-yr survival in 100% of cases. We conclude that great variability of growth patterns exists among and within small hepatocellular carcinomas. Prediction of subsequent growth rate is unreliable in most cases.(ABSTRACT TRUNCATED AT 250 WORDS)

MeSH terms

  • Alcohol Drinking
  • Ascites
  • Carcinoma, Hepatocellular / complications
  • Carcinoma, Hepatocellular / pathology*
  • Carcinoma, Hepatocellular / physiopathology
  • Cell Division
  • Female
  • Follow-Up Studies
  • Hepatitis B Surface Antigens / analysis
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / pathology*
  • Liver Cirrhosis / physiopathology
  • Liver Neoplasms / complications
  • Liver Neoplasms / pathology*
  • Liver Neoplasms / physiopathology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Prothrombin Time
  • Retrospective Studies
  • Time Factors
  • gamma-Glutamyltransferase / blood


  • Hepatitis B Surface Antigens
  • gamma-Glutamyltransferase