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. 2023 Apr 10;12(2):192-204.
doi: 10.21037/hbsn-22-33. Epub 2022 Sep 22.

Prognostication algorithm for non-cirrhotic non-B non-C hepatocellular carcinoma-a multicenter study under the aegis of the French Association of Hepato-Biliary Surgery and liver Transplantation

Charlotte Maulat  1 , Stéphanie Truant  2   3 , Christian Hobeika  4 , Louise Barbier  5 , Astrid Herrero  6 , Alexandre Doussot  7 , Johan Gagnière  8   9 , Édouard Girard  10 , Hadrien Tranchart  11 , Jean-Marc Regimbeau  12 , David Fuks  13 , François Cauchy  4 , Mathieu Prodeau  2 , Antoine Notte  7 , Cyprien Toubert  6 , Ephrem Salamé  5 , Mehdi El Amrani  2 , Sandrine Andrieu  14 , Fabrice Muscari  1 , Jason Shourick  14 , Bertrand Suc  1
Affiliations

Prognostication algorithm for non-cirrhotic non-B non-C hepatocellular carcinoma-a multicenter study under the aegis of the French Association of Hepato-Biliary Surgery and liver Transplantation

Charlotte Maulat et al. Hepatobiliary Surg Nutr. .

Abstract

Background: Liver resection and local ablation are the only curative treatment for non-cirrhotic hepatocellular carcinoma (HCC). Few data exist concerning the prognosis of patients resected for non-cirrhotic HCC. The objectives of this study were to determine the prognostic factors of recurrence-free survival (RFS) and overall survival (OS) and to develop a prognostication algorithm for non-cirrhotic HCC.

Methods: French multicenter retrospective study including HCC patients with non-cirrhotic liver without underlying viral hepatitis: F0, F1 or F2 fibrosis.

Results: A total of 467 patients were included in 11 centers from 2010 to 2018. Non-cirrhotic liver had a fibrosis score of F0 (n=237, 50.7%), F1 (n=127, 27.2%) or F2 (n=103, 22.1%). OS and RFS at 5 years were 59.2% and 34.5%, respectively. In multivariate analysis, microvascular invasion and HCC differentiation were prognostic factors of OS and RFS and the number and size were prognostic factors of RFS (P<0.005). Stratification based on RFS provided an algorithm based on size (P=0.013) and number (P<0.001): 2 HCC with the largest nodule ≤10 cm (n=271, Group 1); 2 HCC with a nodule >10 cm (n=176, Group 2); >2 HCC regardless of size (n=20, Group 3). The 5-year RFS rates were 52.7% (Group 1), 30.1% (Group 2) and 5% (Group 3).

Conclusions: We developed a prognostication algorithm based on the number (≤ or >2) and size (≤ or >10 cm), which could be used as a treatment decision support concerning the need for perioperative therapy. In case of bifocal HCC, surgery should not be a contraindication.

Keywords: Hepatocellular carcinoma (HCC); non-cirrhotic liver; prognostic factors; prognostication algorithm; recurrence-free survival (RFS).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-22-33/coif). LB receives grant to the institution from the national transplant agency (agence de la biomédecine) for a separate project, and payment for legal expertise in liability cases. LB participates on national RCT on antibiotics in appendicitis (ABAP study) without payment. LB is a past board member of the French association for the study of liver diseases (AFEF), past board member of the French Surgical Association (association francaise de chirurgie), and a past board member of the French Association of HPB Surgery and Transplantation (ACHBT) with no payment. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Overall survival.
Figure 2
Figure 2
Recurrence-free survival.
Figure 3
Figure 3
Recurrence-free survival according to two preoperative criteria: the number of nodules and the size of the largest hepatocellular carcinoma nodule. Group 1 (n=271) included patients with 1 or 2 nodules of less than 10 cm, Group 2 (n=176) included patients with 1 or 2 nodules, the largest of which was greater than 10 cm and Group 3 (n=20) included patients with 3 or more nodules.
Figure 4
Figure 4
Recurrence-free survival in the subgroups of patients with 1 or 2 nodules of less than 10 cm: Group 1a (n=72) included patients without microvascular invasion with one or two well differentiated nodules, Group 1b (n=115) included patients without microvascular invasion with one or two poorly or moderately differentiated nodules and Group 1c (n=77) included patients with microvascular invasion on the specimen.
Figure 5
Figure 5
Prognostication algorithm. HCC, hepatocellular carcinoma; RFS, recurrence-free survival.
See this image and copyright information in PMC

Comment in

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