The prognostic significance of macroscopic growth pattern of hepatocellular carcinoma

The relationship between macroscopic growth pattern of main tumor and postoperative survival was retrospectively investigated in 155 patients with resectable hepatocellular carcinoma. The survival of single nodular type (type I, n = 75) was significantly better than that of single nodular type with proliferation into the surrounding area (type II, n = 53) or massive type (type V, n = 13). The frequency of intrahepatic metastasis or portal tumor thrombus in the resected specimens was significantly lower in patients with type I than in those with type II or V (p < 0.05). Patients with type I undergoing segmentectomy (Hr1) had better survival than those with hepatic resections of less than 1 segment (Hr0, p < 0.05). However, such difference was not observed in patients with either type II or V. Moreover, the presence of a cancer-free surgical margin (1 cm or more) significantly affected the long-term prognosis (5-7 years after surgery) in type I but not in type II, suggesting that the intrahepatic spread of tumor might be localized around the main tumor in type I. On the other hand, intrahepatic metastasis and portal involvement were frequently observed in type V and the prognosis was extremely poor even when major hepatic resections were performed. These results indicate that the macroscopic growth pattern of main tumor is an important predictor for hepatocellular carcinoma.