How Should We Assign Large Infiltrative Hepatocellular Carcinomas for Staging?

Abstract

Infiltrative gross morphology of hepatocellular carcinoma (HCC) is known to be associated with poor prognosis, but this is not considered for staging. A total of 774 HCC patients who underwent curative liver resection were retrospectively reviewed and the prognostic significance of infiltrative type HCC was assessed using the American Joint Committee on Cancer (AJCC) and Barcelona Clinic Liver Cancer (BCLC) staging systems. Seventy-four patients (9.6%) had infiltrative HCCs with a higher proportion of multifocal tumors, larger tumors, vessel invasion, increased tumor marker levels, and advanced T-stages than those with nodular HCC (all, p < 0.01). Infiltrative morphology was independently associated with lower overall survival (OS), but its impact was significant when the tumor size was ≥ 4 cm (p < 0.001). Under current AJCC and BCLC staging criteria, these large infiltrative HCCs were associated with significantly worse OS in early AJCC T-stages (T1b/T2, p < 0.001) and BCLC stage A/B (both, p < 0.01) but not in late AJCC (T3/T4) and BCLC C. The reassignment of this subtype to T3 and T4 increased the discriminatory ability of AJCC T-staging with lower AIC values (3090 and 3088 vs. 3109) and higher c-index (0.69 and 0.69 vs. 0.67), respectively (both, p < 0.001). Similarly, the reassignment of large infiltrative HCC to BCLC stages B and C also improved the prognostic performance. Large infiltrative HCCs should be assigned to more advanced stages in current staging systems for their prognostic impact.

A Practical Nomogram and Risk Stratification System Predicting the Cancer-Specific Survival for Patients With Advanced Hepatocellular Carcinoma

“…Tumor staging based on AJCC criteria was the predominant option for predicting prognosis in patients with advanced HCC. However, the effects of age, treatment, marital status, and other variables on patient prognosis were not considered in the traditional AJCC-based criteria ( 28 , 29 ). We synthesized multiple variables affecting CSS in patients with advanced HCC (including demographic and clinicopathologic characteristics) into a nomogram.…”

Accurate prediction of microvascular invasion occurrence and effective prognostic estimation for patients with hepatocellular carcinoma after radical surgical treatment

“…The tumor diameter and TNM stage based on the imageological data also were independent risk factors of for postoperative MVI [29,30]. The greater tumor size might be associated with capsular invasion, satellite nodules, and tumor thrombus, and the poor TNM stage might be relevant to the degree of aggressiveness and malignancy of the tumor [31,32]. In our MVI prediction model, consist of the preoperative AFP ≥ 400 kU/L, TD ≥ 5cm and III-IV TNM stages, demonstrates reasonable composition structure.…”

Accurate prediction of microvascular invasion occurrence and effective prognostic estimation for patients with hepatocellular carcinoma after radical surgical treatment

“…The tumor diameter and TNM stage based on the imaging data are also independent risk factors for postoperative MVI [30,31]. A larger tumor size might be associated with capsular invasion, satellite nodules, and tumor thrombus, and an advanced TNM stage might be relevant to the degree of aggressiveness and malignancy of the tumor [32,33]. In our MVI prediction model, preoperative AFP ≥ 400 kU/L, TD ≥ 5 cm, and TNM stage III-IV demonstrated a reasonable predictive ability of MVI.…”