Clinicopathological Features of Hepatocellular Carcinoma with Metabolic Risk Factors

Lei Sun; Hong Zhao; Xiao-Yan Ding; Kun Yang; Gui-Shuang Wang; Jia-Min Chen; Xiao-Yi Han; Gang Wan; Liang Zhang; Xin-Gang Zhou; Xiang-Mei Chen; Peng Wang; Wen Xie

doi:10.2147/JHC.S412129

Clinicopathological Features of Hepatocellular Carcinoma with Metabolic Risk Factors

J Hepatocell Carcinoma. 2023 Jun 5:10:833-846. doi: 10.2147/JHC.S412129. eCollection 2023.

Authors

Lei Sun¹, Hong Zhao², Xiao-Yan Ding³, Kun Yang¹, Gui-Shuang Wang⁴, Jia-Min Chen¹, Xiao-Yi Han¹, Gang Wan⁵, Liang Zhang¹, Xin-Gang Zhou¹, Xiang-Mei Chen¹, Peng Wang¹, Wen Xie²

Affiliations

¹ Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People's Republic of China.
² Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People's Republic of China.
³ Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People's Republic of China.
⁴ Center of Medical Insurance, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People's Republic of China.
⁵ Department of Medical Records and Statistics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People's Republic of China.

Abstract

Objective: This study aims to explore the pathological characteristics of metabolic-related hepatocellular carcinoma (HCC) and its correlation with metabolic factors.

Methods: Fifty-one patients with liver cancer of unknown causes were enrolled. Biopsy of the liver and staining of the liver tissues with hematoxylin-eosin as well as special and immunohistochemical stains were performed. The histological subtypes of HCC were diagnosed based on the WHO Classification of Malignant Hepatocellular Tumors. The NAFLD activity score system was adopted for assessing the surrounding non-neoplastic liver tissues.

Results: Of the total, 42 (82.4%) patients were diagnosed with HCC, 32 had metabolic risk factors, 20 patients met the diagnostic criteria of the metabolic-associated fatty liver disease (MAFLD)-related HCC, and 40.6% (13/32) had liver cirrhosis. The incidence of cirrhosis (p = 0.033) and diabetes mellitus type 2 (p = 0.036) in patients with MAFLD-related HCC was notably higher than that in HCC patients with only metabolic risk factors. Among the 32 HCC cases with metabolic risk factors, trabecular type was the most prevalent, followed by steatohepatitis type, scirrhous type, solid type, pseudoglandular type, clear-cell type, and macrotrabecular type. The degree of tumor cells' swelling and ballooning was found to be positively related to the degree of fibrosis in the surrounding liver tissues (p = 0.011) as well as the proportion of cirrhosis (p = 0.004). Moreover, the degree of fibrosis in the surrounding liver tissues showed a negative correlation with the levels of serum cholesterol (p = 0.002), low-density lipoprotein (p = 0.002), ApoA1 (p = 0.009), ApoB (p = 0.022), total protein (p = 0.015), WBC count (p = 0.006), and PLT count (p = 0.015).

Conclusion: Pathological characteristics of the tumor and adjacent non-neoplastic liver tissues of HCC with metabolic risk factors were found to be correlated with metabolic abnormalities.

Keywords: MAFLD; hepatocellular carcinoma; metabolic risk factors; metabolic-associated fatty liver disease; pathology.

Grants and funding

This work was supported by Beijing Municipal Administration of Hospitals Incubating Program (PX2022072), Capital‘s Funds for Health Improvement and Research (2022-2-2174) and Research Project of Beijing Municipal Science and Technology Commission (Z191100007619037).