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Macrotrabecular‐massive hepatocellular carcinoma: A distinctive histological subtype with clinical relevance
Author(s) -
Ziol Marianne,
Poté Nicolas,
Amaddeo Giuliana,
Laurent Alexis,
Nault JeanCharles,
Oberti Frédéric,
Costentin Charlotte,
Michalak Sophie,
Bouattour Mohamed,
Francoz Claire,
Pageaux Georges Philippe,
Ramos Jeanne,
Decaens Thomas,
Luciani Alain,
Guiu Boris,
Vilgrain Valérie,
Aubé Christophe,
Derman Jonathan,
Charpy Cécile,
ZucmanRossi Jessica,
Barget Nathalie,
Seror Olivier,
GanneCarrié Nathalie,
Paradis Valérie,
Calderaro Julien
Publication year - 2018
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.29762
Subject(s) - hepatocellular carcinoma , medicine , hazard ratio , gastroenterology , radiofrequency ablation , stage (stratigraphy) , clinical significance , pathological , biopsy , carcinoma , confidence interval , pathology , oncology , ablation , paleontology , biology
We recently identified a histological subtype of hepatocellular carcinoma (HCC), designated as “macrotrabecular‐massive” (MTM‐HCC) and associated with specific molecular features. In order to assess the clinical relevance of this variant, we investigated its prognostic value in two large series of patients with HCC treated by either surgical resection or radiofrequency ablation (RFA). We retrospectively included 237 HCC surgical samples and 284 HCC liver biopsies from patients treated by surgical resection and RFA, respectively. Histological slides were reviewed by pathologists specialized in liver disease, and the MTM‐HCC subtype was defined by the presence of a predominant (>50%) macrotrabecular architecture (more than six cells thick). The main clinical and biological features were recorded at baseline. Clinical endpoints were early and overall recurrence. The MTM‐HCC subtype was identified in 12% of the whole cohort (16% of surgically resected samples, 8.5% of liver biopsy samples). It was associated at baseline with known poor prognostic factors (tumor size, alpha‐fetoprotein level, satellite nodules, and vascular invasion). Multivariate analysis showed that MTM‐HCC subtype was an independent predictor of early and overall recurrence (surgical series: hazard ratio, 3.03; 95% confidence interval, 1.38‐6.65; P = 0.006; and 2.76; 1.63‐4.67; P < 0.001; RFA series: 2.37; 1.36‐4.13; P = 0.002; and 2.19; 1.35‐3.54; P = 0.001, respectively). Its prognostic value was retained even after patient stratification according to common clinical, biological, and pathological features of aggressiveness. No other baseline parameter was independently associated with recurrence in the RFA series. Conclusion: The MTM‐HCC subtype, reliably observed in 12% of patients eligible for curative treatment, represents an aggressive form of HCC that may require more specific therapeutic strategies. (H epatology 2018;68:103‐112).