Clinicopathological features and surgical outcome of patients with fibrolamellar hepatocellular carcinoma (experience with 22 patients over a 15-year period)

Abstract

Aim: To evaluate the clinicopathological features and the surgical outcomes of patients with fibrolamellar hepatocellular carcinoma (FL-HCC) over a 15-year period.

Methods: This is a retrospective study including 22 patients with a pathologic diagnosis of FL-HCC who underwent hepatectomy over a 15-year period. Tumor characteristics, survival and recurrence were evaluated.

Results: There were 11 male and 11 female with a median age of 29 years (range from 21 to 58 years). Two (9%) patients had hepatitis C viral infection and only 2 (9%) patients had alpha-fetoprotein level > 200 ng/mL. The median size of the tumors was 12 cm (range from 5-20 cm). Vascular invasion was detected in 5 (23%) patients. Four (18%) patients had lymph node metastases. The median follow up period was 42 mo and the 5-year survival was 65%. Five (23%) patients had a recurrent disease, 4 of them had a second surgery with 36 mo median time interval. Vascular invasion is the only significant negative prognostic factor.

Conclusion: FL-HCC has a favorable prognosis than common HCC and should be suspected in young patients with non cirrhotic liver. Aggressive surgical resection should be done for all patients. Repeated hepatectomy should be considered for these patients as it has a relatively indolent course.

Keywords: Common hepatocellular carcinoma; Fibrolamellar hepatocellular carcinoma; Pathology of fibrolamellar hepatocellular carcinoma; Recurrence after resection fibrolamellar hepatocellular carcinoma; Survivalefter resection fibrolamellar hepatocellular carcinoma.

Figure 1

Large right lobe fibrolamellar hepatocellular carcinoma.

Figure 2

Fibrolamellar hepatocellular carcinoma left lobe.

Figure 3

Fibrolamellar hepatocellular carcinoma right lobe.

Figure 4

Large retro-caval lynph node 2-year after resection fibrolamellar hepatocellular carcinoma.