Aggressive Histologic Subtypes Drive Poor Outcomes after Percutaneous Ablation for Early Recurrent Hepatocellular
Kyowon Gu1, Min Woo Lee1, Seungchul Han2
1Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Purpose:
To investigate the impact of primary tumor histology on survival and recurrence patterns in patients undergoing ablation for early intrahepatic hepatocellular carcinoma (HCC) recurrence after curative resection.
Materials And Methods:
This single-center retrospective study included 194 patients (mean age, 56.4 years [SD ± 10.4]; 157 [80.9%] men) who underwent ablation for a first intrahepatic HCC recurrence within 2 years of curative resection. The influence of primary tumor histology on recurrence-free survival (RFS), overall survival (OS), and recurrence patterns was evaluated using multivariable Cox and logistic regression analyses.
Results:
Aggressive primary tumor histology (macrotrabecular-massive or scirrhous subtypes) was identified in 29 (14.9%) patients. Multivariable analysis demonstrated aggressive histology as an independent predictor of poorer RFS (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.00-2.57; P = .048) and OS (HR, 2.07; 95% CI, 1.16-3.70; P = .014). A risk model combining histology with clinical factors stratified patients into high- and low-risk groups for RFS (median, 8.2 vs 19.6 months; P = .003) and OS (median, 69.8 months vs not reached; P < .001). Furthermore, aggressive histology was independently associated with aggressive recurrence patterns (infiltrative growth or distant metastasis; odds ratio, 4.42; 95% CI, 1.32-14.3; P = .017).
Conclusions:
Aggressive histology of the resected primary tumor independently predicted poor RFS, poor OS, and aggressive recurrence patterns following ablation for early intrahepatic HCC recurrence after curative resection. These findings support incorporating primary tumor histology into risk stratification and treatment planning for early recurrent HCC.
