Clinicopathologic features of poorly differentiated hepatocellular carcinoma

Oishi, Koichi; Itamoto, Toshiyuki; Amano, Hodaka; Fukuda, Saburo; Ohdan, Hideki; Tashiro, Hirotaka; Shimamoto, Fumio; Asahara, Toshimasa

doi:10.1002/jso.20661

Cited by 83 publications

(63 citation statements)

References 40 publications

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“…The prognosis of welldifferentiated HCCs is good following resection or local therapy [3][4][5][6]. However, moderately/poorly differentiated HCCs have a greater tendency for vascular invasion and metastasis with poorer histological differentiation; the prognosis for poorly differentiated HCCs following resection or local therapy is particularly poor [7][8][9][10]. Fukuda et al [11] investigated cases of resection of HCCs B 2 cm and reported that the frequency of vascular invasion increased with progressing histological differentiation grade.…”

Section: Introductionmentioning

confidence: 99%

Assessment of hepatocellular carcinomas using conventional magnetic resonance imaging correlated with histological differentiation and a serum marker of poor prognosis

et al. 2011

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Purpose To establish a method of assessing the malignant potential of hepatocellular carcinoma (HCC) using magnetic resonance imaging (MRI). Methods For 69 nodules [12 Edmondson (Ed)-I, 48 Ed-II, 9 Ed-III] in 54 HCC patients, signal intensity patterns and enhancement patterns of gadopentate dimeglumine (Gd-DTPA) dynamic studies were correlated with histological differentiation and serum lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3) level, which is an indicator of poor prognosis. Results Hypointensity on T1-weighted imaging was seen in 17, 72, and 89% of Ed-I, Ed-II, and Ed-III HCCs, respectively (P \ 0.001). Meanwhile, hyperintensity on T2-weighted imaging was seen in 42, 88, and 89% (P \ 0.005). Tumor stain during the arterial phase of Gd dynamic MRI was seen in 75, 86, and 89%. Tumor stain washout during the portal phase was seen in 43% of Ed-II and 100% of Ed-III HCCs (P \ 0.005). In the Ed-II and Ed-III HCCs, hypointensity on T1-weighted imaging was seen in 65% of AFP-L3-negative HCCs and 90% of AFP-L3-positive HCCs (P = 0.071). Washout of tumor stain during the portal phase was seen in 39% of AFP-L3-negative HCCs and 75% of AFP-L3-positive HCCs (P \ 0.05). Conclusions Although hyperintensity of tumor on T2-weighted imaging and arterial hypervascularity of tumor are considered to be useful for differential diagnosis between well differentiated HCCs and moderately/poorly differentiated HCCs, hypointensity of tumor on T1-weighted imaging and tumor stain washout during the portal phase of Gd-DTPA dynamic MRI reflected poorer histological differentiation of HCCs and correlated with AFP-L3 levels.

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Section: Introductionmentioning

confidence: 99%

Assessment of hepatocellular carcinomas using conventional magnetic resonance imaging correlated with histological differentiation and a serum marker of poor prognosis

et al. 2011

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“…Oishi et al (25) revealed that differentiation and angiogenic activity, proliferation, tumor size, vascular invasion and AFP ratio were negatively associated. However, Edmonson-Steiner grade was not included in any previous staging system and represents a key variable in the model in the present study.…”

Section: Discussionmentioning

confidence: 99%

Prediction of long‑term survival rates in patients undergoing curative resection for solitary hepatocellular carcinoma

et al. 2017

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Abstract. The present study developed a novel laboratory-based algorithm to predict long-term survival rates in patients undergoing curative resection for solitary hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). The present study included 426 patients with solitary HBV-related HCC who underwent surgery for primary tumors at a single center between 2003 and 2012. Demographic characteristics, laboratory analysis, clinical pathology and immunohistochemistry of topoisomerase II-a and Ki67 were analyzed. A simple prognostic risk calculator was developed using regression coefficients from multivariate models. A prognostic risk calculator incorporating tumor encapsulation, neutrophil-to-lymphocyte ratio, vascular invasion, α-fetoprotein level, Edmondson-Steiner classification, Topo II-α, prognostic nutritional index and Child-Pugh grade was constructed. The prognostic model demonstrated good discrimination with a C-index prior to adjustment of 0.81 (95% confidence interval: 0.78-0.84) and a bootstrap-corrected C-index of 0.81. Kaplan-Meier curves demonstrated that the probabilities of overall survival rates in the low-risk group were increased compared with those in the high-risk group. The areas under the receiver operating characteristic curve using the method were greater compared with those under the 7th Tumor-Node-Metastasis system and Cancer of the Liver Italian Program scoring system [0.83 vs. 0.62 and 0.77 (P<0.001), respectively]. The simple prognostic model of the present study accurately predicted survival rates in patients. Such a prognostic risk calculator for staging patients undergoing curative resection for solitary HBV-related HCC facilitates clinical surveillance and therapy.

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“…In the present case, recurrent tumor after first combined C-TACE and B-TACE with RFA had a rich hypovascular component, and it showed a high ADC value with a high AFP level. Some studies reported that the proportion of hypovascular tumors on CT was higher in well-differentiated HCC (wHCC) and pHCC than in mHCC [3], and Oishi et al reported that a serum AFP level more than 400 ng/mL might be a useful criterion for predicting pHCC [9]. Additionally, Guo et al reported that the ADC value for pHCC was (1.16 0.16) 10 -3 mm 2 /s, and that it was significantly lower than that for wHCC and mHCC [10].…”

Section: Discussionmentioning

confidence: 99%

Transarterial Chemoembolization with and without Microballoon Occlusion for Hypovascular Hepatocellular Carcinoma

Wada

Hirakawa

Miyajima

et al. 2017

Interventional Radiology

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An 85-year-old woman developed locally recurrent hepatocellular carcinoma (HCC) after previous radiofrequency ablation combined with transarterial chemoembolization (TACE). Dynamic computed tomography (CT) and magnetic resonance imaging revealed a hypovascular tumor, which was suspected as poorly differentiated HCC. TACE was performed using a microballoon catheter. First, a suspension of miriplatin mixed with iodized oil (miriplatin-lipiodol suspension [MLS]) was injected without balloon occlusion. When the tumor-feeding artery was near stasis, the balloon was inflated and MLS was forcefully injected. CT after TACE showed accumulation of iodized oil throughout the tumor. The tumor had been controlled without recurrence for 22 months, at the time of writing this manuscript. The therapeutic efficacy of conventional TACE (C-TACE) for poorly differentiated hypovascular HCC is generally limited. In the present case, a good therapeutic result was achieved when balloon-occluded TACE was used in addition to C-TACE.

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Clinicopathologic features of poorly differentiated hepatocellular carcinoma

Abstract: Poorly differentiated HCC tumors larger than 3 cm are already of advanced stage representing distant metastasis in the early period after hepatectomy.

Cited by 83 publications

References 40 publications

Assessment of hepatocellular carcinomas using conventional magnetic resonance imaging correlated with histological differentiation and a serum marker of poor prognosis

Assessment of hepatocellular carcinomas using conventional magnetic resonance imaging correlated with histological differentiation and a serum marker of poor prognosis

Prediction of long‑term survival rates in patients undergoing curative resection for solitary hepatocellular carcinoma

Transarterial Chemoembolization with and without Microballoon Occlusion for Hypovascular Hepatocellular Carcinoma

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