Erschienen in:
28.11.2020 | Hepatobiliary Tumors
Tumor Necrosis Impacts Prognosis of Patients Undergoing Curative-Intent Hepatocellular Carcinoma
verfasst von:
Tao Wei, MD, PhD, Xu-Feng Zhang, MD, Fabio Bagante, MD, Francesca Ratti, MD, Hugo P. Marques, MD, Silvia Silva, MD, Olivier Soubrane, MD, Vincent Lam, MD, George A. Poultsides, MD, Irinel Popescu, MD, Razvan Grigorie, MD, PhD, Sorin Alexandrescu, MD, Guillaume Martel, MD, Aklile Workneh, MD, Alfredo Guglielmi, MD, Tom Hugh, MD, Luca Aldrighetti, MD, Itaru Endo, MD, PhD, Timothy M. Pawlik, MD, MPH, PhD, FACS, FRACS (Hon.)
Erschienen in:
Annals of Surgical Oncology
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Ausgabe 2/2021
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Abstract
Background
The impact of tumor necrosis relative to prognosis among patients undergoing curative-intent resection for hepatocellular carcinoma (HCC) remains ill-defined.
Methods
Patients who underwent curative-intent resection for HCC without any prior treatment between 2000 and 2017 were identified from an international multi-institutional database. Tumor necrosis was graded as absent, moderate (< 50% area), or extensive (≥ 50% area) on histological examination. The relationship between tumor necrosis, clinicopathologic characteristics, and long-term survival were analyzed.
Results
Among 919 patients who underwent curative-intent resection for HCC, the median tumor size was 5.0 cm (IQR, 3.0–8.5). Tumor necrosis was present in 367 (39.9%) patients (no necrosis: n = 552, 60.1% vs < 50% necrosis: n = 256, 27.9% vs ≥ 50% necrosis: n = 111, 12.1%). Extent of tumor necrosis was also associated with more advanced tumor characteristics. HCC necrosis was associated with OS (median OS: no necrosis, 84.0 months vs < 50% necrosis, 73.6 months vs ≥ 50% necrosis: 59.3 months; p < 0.001) and RFS (median RFS: no necrosis, 49.6 months vs < 50% necrosis, 38.3 months vs ≥ 50% necrosis: 26.5 months; p < 0.05). Patients with T1 tumors with extensive ≥ 50% necrosis had an OS comparable to patients with T2 tumors (median OS, 62.9 vs 61.8 months; p = 0.645). In addition, patients with T2 disease with necrosis had long-term outcomes comparable to patients with T3 disease (median OS, 61.8 vs 62.4 months; p = 0.713).
Conclusion
Tumor necrosis was associated with worse OS and RFS, as well as T-category upstaging of patients. A modified AJCC T classification that incorporates tumor necrosis should be considered in prognostic stratification of HCC patients.