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Prognostic impact of vessels encapsulating tumor clusters and macrotrabecular patterns in hepatocellular carcinoma
Jun Akiba1, Masamichi Nakayama2, Eiji Sadashima3
1Department of Diagnostic Pathology, Kurume University Hospital, Asahi-machi 67, Kurume 830-0011, Japan.
Insights
Even small amounts of macrotrabecular (MT) and vessels encapsulating tumor clusters (VETC) patterns in hepatocellular carcinoma (HCC) indicate aggressive disease. Reporting these histological patterns aids in predicting patient prognosis and guiding treatment.
Area of Science:
- Hepatobiliary pathology
- Oncology
- Surgical pathology
Background:
- Hepatocellular carcinoma (HCC) presents a significant mortality challenge.
- Macrotrabecular (MT) and vessels encapsulating tumor clusters (VETC) patterns are recognized as aggressive histological features in HCC.
- Established cut-off values for MT and VETC patterns remain debated.
Purpose of the Study:
- To investigate the prognostic significance of varying percentages of MT and VETC patterns in HCC.
- To determine if low percentages of these aggressive patterns impact patient outcomes.
- To advocate for standardized reporting of MT and VETC patterns in HCC pathology.
Main Methods:
- Retrospective analysis of 985 HCC cases.
- Quantification of MT and VETC pattern percentages in 10% increments.
- Correlation of histological patterns with clinicopathological data and patient prognosis.
Main Results:
- 158 cases had 5-49% MT, and 84 had ≥50% MT.
- 206 cases had 5-49% VETC, and 29 had ≥50% VETC.
- Presence of 5-49% VETC was an independent negative prognostic factor for overall survival (P=0.046).
- MT and VETC patterns were frequently co-occurring (P < 0.001).
Conclusions:
- Even 5% of MT and/or VETC patterns significantly influences HCC patient prognosis.
- Pathological reports should include the quantification of MT and VETC patterns.
- This detailed reporting can improve prognostic accuracy and inform post-operative management strategies.
Background:
Hepatocellular carcinoma (HCC) shows a high mortality rate. A macrotrabecular (MT) pattern and vessels encapsulating tumor clusters (VETC) pattern have been reported as aggressive histological patterns in HCC. However, their cut-off values have been contentious.
Method:
Nine hundred eighty-five cases of previously diagnosed HCC were enrolled. The percentage areas of the MT and/or VETC pattern with ≥ 5% at every 10% increment were assessed. Clinicopathological analysis including patients' prognosis was conducted.
Result:
One hundred fifty-eight and eighty-four cases were accompanied by 5-49% and ≥ 50% MT components, respectively. Two hundred six and twenty-nine cases had 5-49% and ≥ 50% VETC components, respectively. Cases with these histological patterns in common had aggressive characteristics and worse prognosis compared to cases with none of these patterns. The presence of 5-49% VETC pattern was independent worse prognostic factor in overall survival (P = 0.046). HCCs with the MT pattern and the VETC pattern were significantly accompanied by the VETC pattern and the MT pattern (P < 0.001), respectively.
Conclusion:
As even 5% of the MT pattern and/or VETC pattern affected the prognosis of patients with HCC, the amount of these pattern should be described in pathological reports. This information could be useful in expecting patients' prognosis and providing proper post-operative treatments.
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