Prognostic value of desmoplastic growth patterns in resected hepatocellular carcinoma

The prognostic value of histopathological growth patterns is well established in liver metastases, but their significance in hepatocellular carcinoma (HCC) remains uncertain. This study examined the prognostic relevance of the desmoplastic HGP (dHGP) in HCC and explored the impact of the degree of desmoplasia using three assessment methods. We retrospectively analysed 99 patients resected for HCC at two Finnish centres; 74 had adequate tissue for evaluation. HGP was classified as uniform dHGP (44/74) or predominant dHGP (66/74). The degree of desmoplasia was visually estimated as the minimum, maximum, and average distance between tumour cells and adjacent liver parenchyma. Uniform dHGP was not associated with survival in multivariable analysis. Predominant dHGP independently predicted improved overall survival (HR 0.15, 95% CI 0.04-0.51, P = 0.003) and disease-specific survival (HR 0.16, 95% CI 0.04-0.73, P = 0.018). Stronger desmoplasia was associated with improved disease-specific survival across all evaluation methods in multivariable analyses. Uniform and predominant dHGP may be associated with more favourable long-term outcomes in resected HCC, although further investigation is needed, particularly given the small sample size in the predominant non-dHGP group. We present three methods to quantify desmoplasia, providing a basis for future clinical studies.