Characteristics of atypical large well-differentiated hepatocellular carcinoma: a specific subtype of hepatocellular carcinoma?

Masayuki Okuno, Timothy E. Newhook, Katharina Joechle, Yoshikuni Kawaguchi, Mario De Bellis, Ching Wei D. Tzeng, Yun S. Chun, Thomas A. Aloia, Junichi Shindoh, Ahmed O. Kaseb, Jean Nicolas Vauthey

Research output: Contribution to journalArticle

Abstract

Background: Hepatocellular carcinoma (HCC) de-differentiation is thought to correlate with size, therefore well-differentiated HCC ≥3 cm are considered rare and not fully understood. Methods: Patients who underwent hepatectomy for HCC between 1998–2016 were retrospectively analyzed. Patient's characteristics and recurrence-free (RFS) and overall (OS) survival were compared between those with atypical- (well-differentiated-HCC ≥3 cm) and typical-HCC (moderate-to-poorly-differentiated HCC ≥3 cm). Results: Of 176 patients included in this study, 37 (21%) had atypical-HCC. Patients with atypical-HCC were less likely to be Asian ethnicity (3% vs. 17%, p = 0.062), have lower rate of viral infection (14% vs. 43%, p = 0.003), cirrhosis (8% vs. 27%, p = 0.015). The tumors were less likely to demonstrate vascular invasion (30% vs. 59%, p = 0.002), and were associated with a lower alpha-fetoprotein level (3.5 ng/ml vs. 33.2 ng/ml, p < 0.001). Patients with atypical-HCC had a longer RFS (5-y RFS: 58.3% vs. 35.7%, p = 0.016) and OS (5-y OS: 79.1% vs 53.3%, p = 0.029) as compared to those with typical-HCC following univariate analysis, however this did not appear following multivariate analysis. Conclusion: Patients with atypical-HCC have different characteristic in terms of epidemiology, etiology, cirrhosis and vascular invasion as compared to typical-HCC. The etiology of atypical-HCC may be non-alcoholic fatty liver disease-related and/or malignant transformation of hepatocellular adenoma.

Original languageEnglish (US)
JournalHPB
DOIs
StateAccepted/In press - Jan 1 2019

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Hepatocellular Carcinoma
Blood Vessels
Fibrosis
Liver Cell Adenoma
alpha-Fetoproteins
Hepatectomy
Virus Diseases
Epidemiology
Multivariate Analysis
Recurrence
Survival

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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Characteristics of atypical large well-differentiated hepatocellular carcinoma : a specific subtype of hepatocellular carcinoma? / Okuno, Masayuki; Newhook, Timothy E.; Joechle, Katharina; Kawaguchi, Yoshikuni; De Bellis, Mario; Tzeng, Ching Wei D.; Chun, Yun S.; Aloia, Thomas A.; Shindoh, Junichi; Kaseb, Ahmed O.; Vauthey, Jean Nicolas.

In: HPB, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Characteristics of atypical large well-differentiated hepatocellular carcinoma: a specific subtype of hepatocellular carcinoma?",
abstract = "Background: Hepatocellular carcinoma (HCC) de-differentiation is thought to correlate with size, therefore well-differentiated HCC ≥3 cm are considered rare and not fully understood. Methods: Patients who underwent hepatectomy for HCC between 1998–2016 were retrospectively analyzed. Patient's characteristics and recurrence-free (RFS) and overall (OS) survival were compared between those with atypical- (well-differentiated-HCC ≥3 cm) and typical-HCC (moderate-to-poorly-differentiated HCC ≥3 cm). Results: Of 176 patients included in this study, 37 (21{\%}) had atypical-HCC. Patients with atypical-HCC were less likely to be Asian ethnicity (3{\%} vs. 17{\%}, p = 0.062), have lower rate of viral infection (14{\%} vs. 43{\%}, p = 0.003), cirrhosis (8{\%} vs. 27{\%}, p = 0.015). The tumors were less likely to demonstrate vascular invasion (30{\%} vs. 59{\%}, p = 0.002), and were associated with a lower alpha-fetoprotein level (3.5 ng/ml vs. 33.2 ng/ml, p < 0.001). Patients with atypical-HCC had a longer RFS (5-y RFS: 58.3{\%} vs. 35.7{\%}, p = 0.016) and OS (5-y OS: 79.1{\%} vs 53.3{\%}, p = 0.029) as compared to those with typical-HCC following univariate analysis, however this did not appear following multivariate analysis. Conclusion: Patients with atypical-HCC have different characteristic in terms of epidemiology, etiology, cirrhosis and vascular invasion as compared to typical-HCC. The etiology of atypical-HCC may be non-alcoholic fatty liver disease-related and/or malignant transformation of hepatocellular adenoma.",
author = "Masayuki Okuno and Newhook, {Timothy E.} and Katharina Joechle and Yoshikuni Kawaguchi and {De Bellis}, Mario and Tzeng, {Ching Wei D.} and Chun, {Yun S.} and Aloia, {Thomas A.} and Junichi Shindoh and Kaseb, {Ahmed O.} and Vauthey, {Jean Nicolas}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.hpb.2019.08.012",
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TY - JOUR

T1 - Characteristics of atypical large well-differentiated hepatocellular carcinoma

T2 - a specific subtype of hepatocellular carcinoma?

AU - Okuno, Masayuki

AU - Newhook, Timothy E.

AU - Joechle, Katharina

AU - Kawaguchi, Yoshikuni

AU - De Bellis, Mario

AU - Tzeng, Ching Wei D.

AU - Chun, Yun S.

AU - Aloia, Thomas A.

AU - Shindoh, Junichi

AU - Kaseb, Ahmed O.

AU - Vauthey, Jean Nicolas

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Hepatocellular carcinoma (HCC) de-differentiation is thought to correlate with size, therefore well-differentiated HCC ≥3 cm are considered rare and not fully understood. Methods: Patients who underwent hepatectomy for HCC between 1998–2016 were retrospectively analyzed. Patient's characteristics and recurrence-free (RFS) and overall (OS) survival were compared between those with atypical- (well-differentiated-HCC ≥3 cm) and typical-HCC (moderate-to-poorly-differentiated HCC ≥3 cm). Results: Of 176 patients included in this study, 37 (21%) had atypical-HCC. Patients with atypical-HCC were less likely to be Asian ethnicity (3% vs. 17%, p = 0.062), have lower rate of viral infection (14% vs. 43%, p = 0.003), cirrhosis (8% vs. 27%, p = 0.015). The tumors were less likely to demonstrate vascular invasion (30% vs. 59%, p = 0.002), and were associated with a lower alpha-fetoprotein level (3.5 ng/ml vs. 33.2 ng/ml, p < 0.001). Patients with atypical-HCC had a longer RFS (5-y RFS: 58.3% vs. 35.7%, p = 0.016) and OS (5-y OS: 79.1% vs 53.3%, p = 0.029) as compared to those with typical-HCC following univariate analysis, however this did not appear following multivariate analysis. Conclusion: Patients with atypical-HCC have different characteristic in terms of epidemiology, etiology, cirrhosis and vascular invasion as compared to typical-HCC. The etiology of atypical-HCC may be non-alcoholic fatty liver disease-related and/or malignant transformation of hepatocellular adenoma.

AB - Background: Hepatocellular carcinoma (HCC) de-differentiation is thought to correlate with size, therefore well-differentiated HCC ≥3 cm are considered rare and not fully understood. Methods: Patients who underwent hepatectomy for HCC between 1998–2016 were retrospectively analyzed. Patient's characteristics and recurrence-free (RFS) and overall (OS) survival were compared between those with atypical- (well-differentiated-HCC ≥3 cm) and typical-HCC (moderate-to-poorly-differentiated HCC ≥3 cm). Results: Of 176 patients included in this study, 37 (21%) had atypical-HCC. Patients with atypical-HCC were less likely to be Asian ethnicity (3% vs. 17%, p = 0.062), have lower rate of viral infection (14% vs. 43%, p = 0.003), cirrhosis (8% vs. 27%, p = 0.015). The tumors were less likely to demonstrate vascular invasion (30% vs. 59%, p = 0.002), and were associated with a lower alpha-fetoprotein level (3.5 ng/ml vs. 33.2 ng/ml, p < 0.001). Patients with atypical-HCC had a longer RFS (5-y RFS: 58.3% vs. 35.7%, p = 0.016) and OS (5-y OS: 79.1% vs 53.3%, p = 0.029) as compared to those with typical-HCC following univariate analysis, however this did not appear following multivariate analysis. Conclusion: Patients with atypical-HCC have different characteristic in terms of epidemiology, etiology, cirrhosis and vascular invasion as compared to typical-HCC. The etiology of atypical-HCC may be non-alcoholic fatty liver disease-related and/or malignant transformation of hepatocellular adenoma.

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U2 - 10.1016/j.hpb.2019.08.012

DO - 10.1016/j.hpb.2019.08.012

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JF - HPB

SN - 1365-182X

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