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KMID : 1039420180520020085
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Journal of Pathology and Translational Medicine
2018 Volume.52 No. 2 p.85 ~ p.92
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The Clinicopathological and Prognostic Significance of the Gross Classification of Hepatocellular Carcinoma
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Lee Yang-Kyu
Park Hyun-Jin
Lee Hye-Jung
Cho Jai-Young
Yoon Yoo-Seok
Choi Young-Rok
Han Ho-Seong
Jang Eun-Sun
Kim Jin-Wook
Jeong Sook-Hyang
Ahn Soo-Min
Kim Hae-Ryoung
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Abstract
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Background: We aimed to determine the clinicopathological significance of the gross classification of hepatocellular carcinoma (HCC) according to the Korean Liver Cancer Association (KLCA) guidelines.
Methods: A retrospective analysis was performed on 242 cases of consecutively resected solitary primary HCC between 2003 and 2012 at Seoul National University Bundang Hospital. The gross classification (vaguely nodular [VN], expanding nodular [EN], multinodular confluent [MC], nodular with perinodular extension [NP], and infiltrative [INF]) was reviewed for all cases, and were correlated with various clinicopathological features and the expression status of “stemness”-related (cytokeratin 19 [CK19], epithelial cell adhesion molecule [EpCAM]), and epithelial-mesenchymal transition (EMT)?related (urokinase plasminogen activator receptor [uPAR] and Ezrin) markers.
Results: Significant differences were seen in overall survival (p=.015) and disease-free survival (p = .034) according to the gross classification; INF type showed the worst prognosis while VN and EN types were more favorable. When the gross types were simplified into two groups, type 2 HCCs (MC/NP/INF) were more frequently larger and poorly differentiated, and showed more frequent microvascular and portal venous invasion, intratumoral fibrous stroma and higher pT stages compared to type 1 HCCs (EN/VN) (p<.05, all). CK19, EpCAM, uPAR, and ezrin expression was more frequently seen in type 2 HCCs (p<.05, all). Gross classification was an independent predictor of both overall and disease-free survival by multivariate analysis (overall survival: p=.030; hazard ratio, 4.118; 95% confidence interval, 1.142 to 14.844; disease-free survival: p=.016; hazard ratio, 1.617; 95% confidence interval, 1.092 to 2.394).
Conclusions: The gross classification of HCC had significant prognostic value and type 2 HCCs were associated with clinicopathological features of aggressive behavior, increased expression of “stemness”- and EMT-related markers, and decreased survival.
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KEYWORD
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Carcinoma, hepatocellular, Gross classification, Prognosis
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