Prognostic significance of pathologic features of hepatocellular carcinoma: a multivariate analysis of 278 patients

Abstract

Background. In patients with hepatocellular carcinoma, surgical resection may offer a chance of cure. However, tumor recurrence is not infrequent after resection. Methods. To identify the pathologic factors that are of prognostic significance and predictive value in tumor recurrence, the authors studied 278 patients (243 men, 35 women) who had hepatectomy for hepatocellular carcinoma. Disease free and actuarial survival were correlated with 20 pathologic parameters of the resected specimens using multivariate analysis. Results. The median follow-up period was 23.6 months. The overall disease free survival rates at 1, 3 and 5 years were 42%, 23%, and 17%, respectively, and the overall actuarial survival rates for the corresponding time periods were 70%, 39%, and 28%, respectively. The results indicated that tumor encapsulation (P = 0.004) and heavy intratumor inflammatory infiltrates (P = 0.003) were independent favorable factors related to tumor recurrence. Negative resection margins (P = 0.001) and heavy intratumor inflammatory infiltrates (P = 0.003) were independent favorable factors correlated with survival. Conclusions. From this analysis, it was determined that detailed histologic examination of resected specimens of hepatocellular carcinoma is important in assessing long term prognosis and stratification of patients for treatment.