Relationships Between Indices of Tumor Aggressiveness in Hepatocellular Carcinoma

Abstract

Background Hepatocellular carcinoma (HCC) aggressiveness factors include serum levels of alpha-fetoprotein (AFP), maximum tumor diameter (MTD), tumor multifocality, and presence of portal vein thrombosis (PVT). Aims The interdependence of these factors has not been closely studied. Methods A large HCC database was examined for the presence of patients with PVT and multifocality and was analyzed retrospectively for the relationship of these 2 parameters to each other and to MTD and survival. Results Multifocality was found to increase with increase in MTD in the whole cohort and especially in patients with PVT. PVT also increased with increasing MTD. Neither increases in multifocality nor in PVT depended on elevated serum AFP levels, although they each increased with higher AFP levels. PVT increased in monofocal tumors as MTD increased but increased further in multifocal tumors. Conclusions Multifocality and PVT appear to be separate processes, each increasing with increase in MTD and AFP levels. The data support the hypothesis that in hepatocarcinogenesis, various factors cause increase in MTD, that in turn causes increased multifocality and PVT, which are non-co-dependent. However, both multifocality and PVT mechanisms involve both HCC cell growth and invasiveness, multifocality in liver parenchyma, and PVT in the portal vein.

Tumor Burden in Patients With Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Head-to-Head Comparison of Current Scoring Systems

“…Macrovascular tumor invasion has been identified as an independent factor in these patients ( 38 , 39 ). Although macrovascular invasion appears more often in patients with higher tumor burden, it is not necessarily associated to multifocal tumor growth ( 40 ). Therefore, apart from the tumor burden, macrovascular invasion has to be considered as an additional and independent factor when evaluating biological tumor aggressiveness in these patients.…”