Proposal of objective morphological classification system for hepatocellular carcinoma using preoperative multiphase
Hisashi Nakayama1, Tadatoshi Takayama, Takao Okubo
1Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan, nakayama.hisashi@nihon-u.ac.jp.
Journal of Gastroenterology
|November 19, 2013
Summary
A new computed tomography (CT) classification system for hepatocellular carcinoma (HCC) identifies three tumor shapes: smooth, jagged, and rough. Rough HCC shapes show significantly worse survival rates and higher portal venous invasion, indicating prognostic value.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Hepatocellular carcinoma (HCC) is a significant global health concern.
- Accurate preoperative assessment is crucial for patient management and prognosis.
- Existing classification systems may not fully capture morphological nuances relevant to HCC behavior.
Purpose of the Study:
- To develop and validate a preoperative morphological classification system for hepatocellular carcinoma (HCC) using multiphase computed tomography (CT).
- To correlate distinct HCC morphological features with patient survival and disease progression.
Main Methods:
- A cohort of 232 patients with HCC diagnosed between 2004 and 2009 were analyzed.
- Multiphase CT scans were used to quantify tumor contour concavity, convexity, and indentation characteristics.
- Feature values, including indentation area to tumor area ratio (s:S) and a combined ratio (s:S × d:t), were calculated.
Main Results:
- Hierarchical cluster analysis classified HCC into three morphological types: Type I (smooth, n=158), Type II (jagged, n=63), and Type III (rough, n=11).
- Five-year survival rates were significantly different across types (Type I: 64%, Type II: 53%, Type III: 0%).
- Type III HCC demonstrated a significantly higher incidence of microscopic portal venous invasion compared to Types I and II.
Conclusions:
- A novel CT-based morphological classification system for HCC has been established.
- This system provides a promising tool for preoperative prognostic categorization of HCC patients.
- Morphological tumor characteristics identified via CT correlate with clinical outcomes and disease behavior.
