Association of tumor morphology with long-term prognosis after liver resection for patients with a solitary huge hepatocellular carcinoma-a multicenter propensity score matching analysis

Abstract

Background: A solitary hepatocellular carcinoma (HCC) without macrovascular invasion and distant metastasis, regardless of tumor size, is currently classified as early-stage disease by the latest Barcelona Clinic Liver Cancer (BCLC) staging system. While the preferred treatment is surgical resection, the association of tumor morphology with long-term survival outcomes after liver resection for a solitary huge HCC of ≥10 cm has not been defined.

Methods: Patients who underwent curative liver resection for a solitary huge HCC were identified from a multicenter database. Preoperative imaging findings were used to define spherical- or ellipsoidal-shaped lesions with smooth edges as balloon-shaped HCCs (BS-HCCs); out-of-shape lesions or lesions of any shape with matt edges were defined as non-balloon-shaped HCCs (NBS-HCCs). The two groups of patients with BS-HCCs and NBS-HCCs were matched in a 1:1 ratio using propensity score matching (PSM). Clinicopathologic characteristics, long-term overall survival (OS) and recurrence-free survival (RFS) were assessed.

Results: Among patients with a solitary huge HCC, 74 pairs of patients with BS-HCC and NBS-HCC were matched. Tumor pathological features including proportions of microvascular invasion, satellite nodules, and incomplete tumor encapsulation in the BS-HCC group were lower than the NBS-HCC group. At a median follow-up of 50.7 months, median OS and RFS of all patients with a solitary huge HCC after PSM were 27.8 and 10.1 months, respectively. The BS-HCC group had better median OS and RFS than the NBS-HCC group (31.9 vs. 21.0 months, P=0.01; and 19.7 vs. 6.4 months, P=0.015). Multivariate analyses identified BS-HCC as independently associated with better OS (HR =0.592, P=0.009) and RFS (HR =0.633, P=0.013).

Conclusions: For a solitary huge HCC, preoperative imaging on tumor morphology was associated with prognosis following resection. In particular, patients with BS-HCCs had better long-term survival following liver resection versus patients with large NBS-HCCs.

Keywords: Hepatocellular carcinoma (HCC); hepatectomy; recurrence; survival; tumor morphology.

Figure 1

A representative set of MRI, three-dimensional imaging, and operative photographs of a 45-year-old male with a solitary huge BS-HCC located between the left and right hemilivers. MRI (A,B) and three-dimensional imaging (C) show a solitary huge lesion located in segments 4, 5, and 8 (largest tumor size: 11.0 cm). The preoperative AFP was 48.9 ng/mL. This patient underwent curative extended right hepatectomy (D-F) on November 02, 2017, and was still alive and recurrence-free at the last follow-up on July 20, 2021. MRI, magnetic resonance imaging; BS-HCC, balloon-shaped hepatocellular carcinoma; AFP, alpha-fetoprotein.

Figure 2

Flow chart of the study. HCC, hepatocellular carcinoma; CT, computed tomography; MRI, magnetic resonance imaging; PSM, propensity score matching.

Figure 3

Curves of OS (A) and RFS (B) after liver resection for patients with a solitary huge HCC. OS, overall survival; RFS, recurrence-free survival; HCC, hepatocellular carcinoma.

Figure 4

Comparison curves of OS (A) and RFS (B) after liver resection for a solitary huge HCC between patients with BS-HCC and NBS-HCC. BS-HCC, balloon-shaped hepatocellular carcinoma; NBS-HCC, non-balloon-shaped hepatocellular carcinoma; OS, overall survival; RFS, recurrence-free survival.