Open AccessHistology of Hepatocellular Carcinoma: Association with Clinical Features, Radiological Findings, and Locoregional Therapy Outcomes
Author(s) -
Benjamin V. Park,
Ron C. Gaba,
Yuhui Huang,
Yifan Chen,
Grace Guzman,
R. Peter Lokken
Publication year - 2019
Publication title -
journal of clinical imaging science
Language(s) - English
Resource type - Journals
eISSN - 2156-7514
pISSN - 2156-5597
DOI - 10.25259/jcis_111_2019
Subject(s) - medicine , hepatocellular carcinoma , hazard ratio , gastroenterology , stage (stratigraphy) , confidence interval , odds ratio , histology , cirrhosis , proportional hazards model , retrospective cohort study , paleontology , biology
Objective: The objective of the study was to investigate whether hepatocellular carcinoma (HCC) histology is associated with clinical and computed tomographic/magnetic resonance imaging features and locoregional therapy (LRT) outcomes. Subjects and Methods: This single-center retrospective study included 124 consecutive patients (92 men, median age 59 years) with 132 HCC diagnosed by biopsy between 2008 and 2017 before LRT. Patients underwent chemoembolization ( n = 51, 41%), ablation ( n = 41, 33%), yttrium-90 radioembolization ( n = 17, 13%), and chemoembolization/ablation ( n = 15, 12%). Barcelona clinic liver cancer (BCLC) stage was 0/A ( n = 48, 38%), B ( n = 33, 26%), C ( n = 27, 22%), and D ( n = 16, 13%). Edmondson-Steiner (ES) grade and cytology were correlated with baseline features and radiologic response using logistic regression. Time to progression (TTP) and transplant-free survival (TFS) were analyzed using Cox proportional hazard models. Results: High ES grade was associated with α-fetoprotein (AFP) >50 ng/ml (odds ratio [OR] 4.6, 95% confidence interval [CI]: 1.5–13.9; P 5 cm (OR 3.1, 95% CI: 1.1–9.0; P 0.20), or TFS ( P > 0.90) on univariate or stratified analysis. Conclusion: Histologic grade is associated with aggressive tumor features, while clear-cell HCC is associated with non-viral cirrhosis and atypical enhancement. Unlike AFP, BCLC stage, and tumor size, histologic features were not associated with LRT outcomes, supporting biopsy deferral for imaging diagnosed HCC.