Hepatocellular carcinoma (HCC) is usually associated with varying degrees of
cirrhosis. Among cirrhotic patients with solitary HCC in the absence of macro-vascular invasion, whether
tumor size drives prognosis or not after
hepatectomy remains unknown. This study aimed to investigate the prognostic impact of
tumor size on long-term outcomes after
hepatectomy for solitary HCC patients with
cirrhosis and without macrovascular invasion. A total of 813 cirrhotic patients who underwent curative
hepatectomy for solitary HCC and without macrovascular invasion between 2001 and 2014 were retrospectively studied. We set 5 cm as the
tumor cut-off value. Propensity score matching (PSM) was performed to minimize the influence of potential confounders including cirrhotic severity that was histologically assessed according to the Laennec staging system. Recurrence-free survival (RFS) and overall survival (OS) were compared between the two groups before and after PSM. Overall, 464 patients had
tumor size ≤ 5 cm, and 349 had
tumor size > 5 cm. The 5-year RFS and OS rates were 38.3% and 61.5% in the ≤ 5 cm group, compared with 25.1% and 59.9% in the > 5 cm group. Long-term survival outcomes were significantly worse as
tumor size increased. Multivariate analysis indicated that
tumor size > 5 cm was an independent risk factor for
tumor recurrence and long-term survival. These results were further confirmed in the PSM cohort of 235 pairs of patients. In cirrhotic patients with solitary HCC and without macrovascular invasion,
tumor size may significantly affect the prognosis after curative
hepatectomy.