Histology of Hepatocellular Carcinoma: Association with Clinical Features, Radiological Findings, and Locoregional Therapy Outcomes.

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 ( = 51, 41%), ablation ( = 41, 33%), yttrium-90 radioembolization ( = 17, 13%), and chemoembolization/ablation ( = 15, 12%). Barcelona clinic liver cancer (BCLC) stage was 0/A ( = 48, 38%), B ( = 33, 26%), C ( = 27, 22%), and D ( = 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; < 0.01), tumor diameter >5 cm (OR 3.1, 95% CI: 1.1-9.0; < 0.05), infiltrative appearance (OR 5.0, 95% CI: 1.5-16.2; < 0.01), and BCLC Stage C (OR 4.5, 95% CI: 1.3-16.4; = 0.02). Clear-cell subtype was associated with non-viral cirrhosis (OR 5.3, 95% CI: 1.6-17.2; < 0.01) and atypical enhancement (OR 3.1, 95% CI: 1.0-9.3; < 0.05). AFP, BCLC Stage B, and diameter were associated with reduced TTP and TFS ( < 0.05). Neither ES grade nor clear-cell subtype was associated with objective response (OR 2.3, 95% CI: 0.7- 7.4; = 0.15 and OR 1.1, 95% CI: 0.4-3.4; = 0.87, respectively), TTP ( > 0.20), or TFS ( > 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.