Recently, I met a patient with HCC recurrence, who received liver resection just 5 months ago, and followed with twice TACE treatment.
The primary single tumor is small, just 2cm diameter. APF is higher than 2000.
This is not the first time I met the patient like this. According to my experience, I feel that the recurrence is more easily detected in small HCC than big HCC. I searched many papers, but without relevant evidence.
Does someone have the idea about this issue?
Thanks for you answer in advance!
Appears that the tumor biological behaviour is responsible for it. So the doubling time for each tumor varies. This observation of yours is important since even after meticulous survillance, in many areas of the World, only large unresectable tumors are derected. Moreover, your patient must have bern on strict follow up and survillance since he had undergone resection.
There is a known proverb that says that "Surgery is Prince, selection of cases is Queen and Biology is King" You can find your answer looking at this proverb.
However, in my opinion the most important fact is that when you have a large HCC and you proceed with surgery it means that it has not spread to other organs, not spread to lymphnodes and usually is a single tumor with no satellite lesions. This is your favorable biology right in front of you telling you that you can go with the operation and it may no recur. All other large tumors are not referred to you because the bad biology has already surfaced.
On the other hand, when you have a small tumor you have no idea if the biology is favorable or not because there was no enough time for the tumor to show distance metastases or lymphnodes and we expect cure in those cases and we are frequently deceived. In this context you are going to operate more small tumors with uncertain biology and whenever you face a really mean biology, it will strike back with full force like your case mentioned above.
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