P-0026 - Rediscovering Kojiro's Classification: The Importance of Small Tumor Evaluation in HCC

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Hepatobiliary Cancers
Pathology/Molecular Biology
Presenter M Martins Aline
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors M. Martins Aline1, M. Silva2, G. Coelho3, O. Moraes Manoel2, H. Garcia José3, T. Valença Jr José4
  • 1University Hospital HUWC-UFC / UDF, Fortaleza/BR
  • 2Federal University of Ceara - UFC, Fortaleza/BR
  • 3Liver Transplantation Center, HUWC, Fortaleza/BR
  • 4Pathology and Forensic Department, Federal University of Ceara State - UFC, Fortaleza/BR



The HCC is the most common liver primary malignancy worldwide. In Brazil, the diagnosis of HCC follows the Milan and Barcelona Criteria, and the priority between patients in the waiting list is defined by the MELD score. These rules are regulated by Ordinance GM nº1.160; nonetheless it not consider as HCC, tumors that present size ≤2cm. The aim of this work is to characterize and evaluated small tumors (≤2 cm) from patients diagnosed with HCC.


We evaluated small tumors in 61 patients underwent orthotopic liver transplant in HUWC/UFC, due to Kojiro's classification as, distinctly nodular/vaguely nodular, and its correlation with disease-free survival, MELD score, AFP levels, AFP sensibility and specificity, Edmondson-Steiner grading, number of small tumors and vascular invasion. The statistical data analysis was performed using GraphPad Prism (submitted to the COMEPE/UFC n.26/08).


Positive correlation where find between tumor differentiation (Edmondson-Steiner grading) x tumor size x number of small tumors (Two-way ANOVA; p ≤ 0.0001); between disease-free survival x number of small tumors (Kaplan-Meier and Mantel-Cox Test; p ≤ 0.0163); number of small tumors (≥2cm n ≤2cm) x disease-free survival (Fisher's Test; p ≤ 0.0462) and specificity and sensibility of AFP levels (p ≤ 0.0137). No other positive correlations were obtained.


HCC small tumors are considered to have a low potential for malignancy. Nonetheless, pour is know about these neoplastic features and patterns due to clinical characteristics. Prospective and retrospective reviews are strongly recommended to be undertaken; especially one's regards to small tumors Kojiro's classification. Although, worldwide criteria do not consider these type of tumors as an imminent treat, careful evaluation must be fulfill, as some attributes are consider relevant to clinical prognosis as failure on AFP specificity and sensibility and its relationship due to number of tumors per patient.