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Updated: Dec 9, 2025

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How Should We Assign Large Infiltrative Hepatocellular Carcinomas for Staging?

Yoo Jin Lee1, Yoo Ra Lee2, Chung Gyo Seo2

  • 1Department of Pathology, Korea University Medical Center, Seoul 136-701, Korea.

Cancers
|September 15, 2020
PubMed
Summary

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This summary is machine-generated.

Infiltrative hepatocellular carcinoma (HCC) morphology indicates poor prognosis. Reclassifying large infiltrative HCCs into higher stages improves current staging systems for better patient outcome prediction.

Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Gastroenterology

Background:

  • Infiltrative gross morphology in hepatocellular carcinoma (HCC) is linked to poorer patient outcomes.
  • Current staging systems, including the American Joint Committee on Cancer (AJCC) and Barcelona Clinic Liver Cancer (BCLC), do not fully account for infiltrative HCC morphology.

Purpose of the Study:

  • To assess the prognostic significance of infiltrative HCC morphology.
  • To evaluate the impact of infiltrative HCC on existing AJCC and BCLC staging systems.
  • To determine if reclassifying infiltrative HCC improves prognostic accuracy.

Main Methods:

  • Retrospective review of 774 HCC patients undergoing curative liver resection.
  • Comparative analysis of infiltrative versus nodular HCC characteristics.
Keywords:
AJCC 8th staging systemgross morphologyhepatocellular carcinomainfiltrative typenodular typeoverall survivalprognostic efficacy

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  • Assessment of overall survival (OS) in relation to tumor morphology and staging systems.
  • Statistical evaluation using AIC and c-index for staging system discriminatory ability.

    • Main Results:

    • Infiltrative HCC (9.6% of cases) showed higher rates of multifocal tumors, larger size, vessel invasion, elevated tumor markers, and advanced T-stages.
    • Infiltrative morphology was an independent predictor of lower OS, particularly for tumors ≥ 4 cm.
    • Reclassifying large infiltrative HCCs into higher AJCC and BCLC stages significantly improved prognostic accuracy and discriminatory ability.
    • Current staging systems underestimated the poor prognosis associated with large infiltrative HCCs in early stages.

    Conclusions:

    • Infiltrative gross morphology is a critical prognostic factor in HCC.
    • Current AJCC and BCLC staging systems require modification to incorporate the prognostic impact of large infiltrative HCC.
    • Assigning large infiltrative HCCs to more advanced stages is recommended for improved prognostic stratification and patient management.