Prognostic comparison between LNM and MaVI of hepatocellular carcinoma: a multicenter population-based propensity...

Hepatocellular carcinoma (HCC) with lymph node metastases (LNM) is an uncommon neoplasm and has an ambivalent prognosis compared to the common type of HCC with macrovascular invasion (MaVI).

In this study, the clinical data of patients were extracted from Surveillance, Epidemiology, and End Results (SEER) and Southeast Big Data Institute of Hepatobiliary Health, Mengchao Hepatobiliary Hospital of Fujian Medical University. The K-M survival curve described overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) between LNM and MaVI. Prognostic factors were identified by univariate and multivariate Cox regression analysis. Additionally, propensity score matching (PSM) was performed to minimize the potential confounding factors to facilitate a more reliable conclusion.

A total of 3,326 HCC patients were included in our study. In the SEER cohort, after PSM, the 1-, 3-, and 5-year OS rates were 41.1%, 13.8%, and 8.8% in Group LNM and 28.3%, 11.0%, and 7.1% in Group MaVI (p < 0.001). The 1-, 3-, and 5-year CSS rates were 46.5%, 17.6%, and 12.0% in Group LNM and 32.2%, 14.3%, and 9.7% in Group MaVI (p < 0.001). Multivariate Cox analysis showed that LNM had better OS (HR = 0.79, 95% CI = 0.71-0.89, p < 0.001) and CSS (HR = 0.78, 95% CI = 0.70-0.88, p < 0.001) compared to MaVI. In the hospital cohort, the 1-, 3-, and 5-year OS rates were 57.5%, 42.6%, and 36.3% in Group LNM and 56.3%, 27.4%, and 14.3% in Group MaVI (p = 0.038). The 1-, 3-, and 5-year RFS rates were 40.7%, 32.3%, and 23.5% in Group LNM and 28.9%, 13.0%, and 5.7% in Group MaVI (p = 0.015). Multivariate Cox analysis revealed similar OS (HR = 0.83, 95% CI = 0.57-1.23, p = 0.361) and CSS (HR = 0.76, 95% CI = 0.53-1.10, p = 0.142) between LNM and MaVI.

This study found that the current HCC AJCC TNM staging system cannot accurately distinguish the prognosis of LNM and MaVI patients. For patients undergoing hepatectomy, HCC with LNM may obtain a better prognosis than that of HCC with MaVI. Future research requires additional clinical data to further corroborate this finding.