How Should We Assign Large Infiltrative Hepatocellular Carcinomas for Staging?

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.
• 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.