Impact of disparity between imaging and pathological tumor size on cancer-specific prognosis among patients with hepatocellular carcinoma

Miho Akabane ¹, Jun Kawashima ¹, Abdullah Altaf ¹

¹Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
²Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France.
³Department of General Surgery, Cleveland Clinic Foundation, OH, USA.
⁴Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
⁵Department of Surgery, Keio University, Tokyo, Japan.
⁶Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
⁷Department of Surgery, Ospedale San Raffaele, Milan, Italy.
⁸Department of Surgery, Stanford University, Stanford, CA, USA.
⁹Department of Surgery, University of Verona, Verona, Italy.
¹⁰Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
¹¹Department of Surgery, University of Colorado, Denver, CO, USA.
¹²Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
¹³Department of Surgery, Westmead Hospital, Sydney, NSW, Australia.
¹⁴Department of Surgery, School of Medicine, The University of Sydney, Sydney, NSW, Australia.
¹⁵The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.

⁰Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology +

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February 26, 2025

View abstract on PubMed

Summary

Tumor size disparity between imaging and pathology in hepatocellular carcinoma (HCC) patients undergoing hepatectomy is linked to worse cancer-specific survival. Cirrhosis and AFP levels can predict this disparity, aiding in identifying high-risk patients.

Area Of Science

Hepatocellular Carcinoma Research
Surgical Oncology
Medical Imaging Analysis

Background

The relationship between preoperative imaging tumor size and postoperative pathological tumor size, and its impact on cancer-specific survival (CSS) in hepatocellular carcinoma (HCC) patients undergoing hepatectomy is not well-understood.
This study aimed to investigate the association between preoperative imaging and pathological tumor size disparity and CSS in HCC patients undergoing hepatectomy.
Predictors of tumor size disparity were also identified.

Purpose Of The Study

To evaluate the association between preoperative imaging and postoperative pathological tumor size disparity and cancer-specific survival (CSS) in patients undergoing hepatectomy for hepatocellular carcinoma (HCC).
To identify preoperative predictors of tumor size disparity in HCC patients undergoing hepatectomy.

Main Methods

Utilized an international, multi-institutional database of patients undergoing curative-intent hepatectomy for HCC from 2000-2023.
Defined size ratio as pathological to imaging tumor size; patients with a ratio of 0.5-1.5 were classified as 'without size disparity'.
Employed multivariable Cox and logistic regression analyses to identify predictors of CSS and size disparity, respectively, with ROC analysis for further evaluation.

Main Results

Among 833 patients, 12.7% exhibited size disparity, with a median size ratio of 1.02.
Patients with size disparity had significantly worse 5-year CSS (60.1% vs. 79.0%; p < 0.001).
Higher ALBI score, larger pathological tumor size, and size disparity were independent predictors of CSS, while cirrhosis and log alpha-fetoprotein (AFP) were associated with increased likelihood of size disparity.

Conclusions

Tumor size disparity is significantly associated with worse CSS in HCC patients undergoing hepatectomy.
Preoperative cirrhosis status and AFP levels can predict tumor size disparity, enabling stratification of patients into risk groups.
Identifying patients with potential size disparity may facilitate more detailed imaging assessments and personalized treatment strategies.

Keywords:

Cancer-specific survival (CSS) Hepatectomy Hepatocellular carcinoma (HCC) Imaging Pathology Tumor size