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

作者：Xu, Xin-Fei; Wu, Han; Li, Ju-Dong; Yao, Lan-Qing; Huang, Bin; Diao, Yong-Kang; Chen, Ting-Hao; Gu, Wei-Min; Chen, Zhong; Li, Jie; Zhang, Yao-Ming; Wang, Hong; Liang, Ying-Jian; Zhou, Ya-Hao; Li, Chao; Wang, Ming-Da; Zhang, Cheng-Wu; Pawlik, Timothy M.; Lau, Wan Yee; Shen, Feng^*; Yang, Tian^*

来源：HEPATOBILIARY SURGERY AND NUTRITION, 2023, 12(3): 314-+.

DOI：10.21037/hbsn-21-423

• Hepatocellular carcinoma (HCC)
• survival
• recurrence
• tumor morphology
• hepatectomy

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.

• 单位
  南通大学; 哈尔滨医科大学; 1