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

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

doi:10.21037/hbsn-21-423

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

Hepatobiliary Surg Nutr. 2023 Jun 1;12(3):314-327. doi: 10.21037/hbsn-21-423. Epub 2022 Feb 15.

Authors

Xin-Fei Xu^#¹, Han Wu^#¹, Ju-Dong Li^#², Lan-Qing Yao^#¹, Bin Huang³, Yong-Kang Diao⁴, Ting-Hao Chen⁵, Wei-Min Gu⁶, Zhong Chen⁷, Jie Li⁸, Yao-Ming Zhang⁹, Hong Wang¹⁰, Ying-Jian Liang¹¹, Ya-Hao Zhou¹², Chao Li¹, Ming-Da Wang¹, Cheng-Wu Zhang⁴, Timothy M Pawlik¹³, Wan Yee Lau^{1

14}, Feng Shen¹, Tian Yang^{1

4}

Affiliations

¹ Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University), Shanghai, China.
² Department of General Surgery, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China.
³ Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University (Second Military Medical University), Shanghai, China.
⁴ Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Cancer Center, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
⁵ Department of General Surgery, Ziyang First People's Hospital, Ziyang, China.
⁶ The First Department of General Surgery, the Fourth Hospital of Harbin, Harbin, China.
⁷ Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong, China.
⁸ Department of Hepatobiliary Surgery, Fuyang People's Hospital, Fuyang, China.
⁹ The Second Department of Hepatobiliary Surgery, Meizhou People's Hospital, Meizhou, China.
¹⁰ Department of General Surgery, Liuyang People's Hospital, Changsha, China.
¹¹ Department of Hepatobiliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
¹² Department of Hepatobiliary Surgery, Pu'er People's Hospital, Pu'er, China.
¹³ Department of Surgery, Ohio State University, Wexner Medical Center, Columbus, OH, USA.
¹⁴ Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.

^# Contributed equally.

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.