Chopinet Sophie, Cauchy François, Hobeika Christian, Beaufrère Aurélie, Poté Nicolas, Farges Olivier, Dokmak Safi, Bouattour Mohamed, Ronot Maxime, Vilgrain Valérie, Paradis Valérie, Soubrane Olivier
Department of HPB and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France.
Department of Pathology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France.
JHEP Rep. 2021 Jun 29;3(4):100326. doi: 10.1016/j.jhepr.2021.100326. eCollection 2021 Aug.
BACKGROUND & AIMS: Malignant transformation of hepatocellular adenoma (MT-HCA) may occur in up to 5% of tumours. However, the prognostic value of this event remains poorly described. In this study, we aimed to analyse the long-term outcomes of patients undergoing liver resection (LR) for MT-HCA compared to those of patients resected for hepatocellular carcinoma (HCC) occurring on normal liver parenchyma (NP-HCC).
This single-centre retrospective study included all patients who underwent LR for MT-HCA at Beaujon Hospital between 2001 and 2019. MT-HCAs were classified as small foci of malignant transformation HCA (SF-HCA) and as malignant HCA (M-HCA) in cases of predominant HCC foci. Recurrence-free survival (RFS) of MT-HCA was compared with that of NP-HCC after propensity score matching.
Forty patients (24 men, 16 women) underwent LR for MT-HCA, including 23 with SF-HCA and 17 with M-HCA. Of these cases, 16/40 (40%) had β-catenin mutations, 19/40 (47.5%) were inflammatory, 1 was HNF1α-mutated HCA and 4 (10%) were unclassified HCA. Microvascular invasion (12% 0%, 0.091) and satellite nodules (25% 4%, 0.028) were more frequently observed in M-HCA than in SF-HCA. After a median follow-up of 67 months, 10 (25%) patients with MT-HCA had tumour recurrence, including 9 with M-HCA and 1 with SF-HCA ( 0.007). M-HCA was linked to significantly poorer 1-, 3-, 5- and 10-year RFS rates than SF-HCA (76%, 63%, 39%, 37% 100%, 100%, 100%, 91%, 0.003). Multivariate analysis showed that SF-HCA was independently associated with improved RFS (hazard ratio 0.064; 95% CI 0.008-0.519; 0.01). After propensity score matching, NP-HCC was associated with significantly poorer 1-, 3-, 5- and 10-year RFS rates than MT-HCA ( 0.01).
HCA with malignant transformation yields a better long-term prognosis than NP-HCC. Among MT-HCA, SF-HCA is associated with a better prognosis than M-HCA.
The prognostic relevance of malignant transformation of hepatocellular adenoma (HCA) remains unknown. Thus, the aim of our study was to compare the outcomes of patients undergoing liver resection for malignant transformation to those of patients undergoing liver resection for hepatocellular carcinoma (HCC). The main long-term risk after resection for carcinoma is recurrence. In this study, 10/40 patients with malignant transformation of HCA relapsed after resection and we identified age >55 years, presence of satellite nodes, and microvascular invasion as risk factors for long-term recurrence. Compared to patients with HCC, patients who underwent liver resection for HCA with malignant transformation had better long-term survival.
肝细胞腺瘤的恶性转化（MT-HCA）在高达5%的肿瘤中可能发生。然而，这一事件的预后价值仍描述甚少。在本研究中，我们旨在分析接受肝切除术（LR）治疗MT-HCA的患者与因正常肝实质发生肝细胞癌（HCC）而接受切除术的患者（NP-HCC）的长期结局。
这项单中心回顾性研究纳入了2001年至2019年期间在博若医院接受LR治疗MT-HCA的所有患者。MT-HCA被分类为恶性转化小灶性HCA（SF-HCA），以及主要为HCC灶的恶性HCA（M-HCA）。在倾向评分匹配后，比较MT-HCA与NP-HCC的无复发生存期（RFS）。
40例患者（24例男性，16例女性）接受了LR治疗MT-HCA，其中23例为SF-HCA，17例为M-HCA。在这些病例中，16/40（40%）有β-连环蛋白突变，19/40（47.5%）为炎症性，1例为HNF1α突变型HCA，4例（10%）为未分类HCA。微血管侵犯（12%对0%，P = 0.091）和卫星结节（25%对4%，P = 0.028）在M-HCA中比在SF-HCA中更常见。中位随访67个月后，10例（25%）MT-HCA患者出现肿瘤复发，其中9例为M-HCA，1例为SF-HCA（P = 0.007）。M-HCA与1年、3年、5年和10年RFS率显著低于SF-HCA相关（76%、63%、39%、37%对100%、100%、100%、91%，P = 0.003）。多因素分析显示，SF-HCA与改善的RFS独立相关（风险比0.064；95%CI 0.008 - 0.519；P = 0.01）。在倾向评分匹配后，NP-HCC与1年、3年、5年和10年RFS率显著低于MT-HCA相关（P = 0.01）。
发生恶性转化的HCA比NP-HCC具有更好的长期预后。在MT-HCA中，SF-HCA比M-HCA预后更好。
肝细胞腺瘤（HCA）恶性转化的预后相关性尚不清楚。因此，我们研究的目的是比较接受肝切除术治疗恶性转化的患者与接受肝切除术治疗肝细胞癌（HCC）的患者的结局。癌切除术后的主要长期风险是复发。在本研究中，10/40例HCA恶性转化患者切除术后复发，我们确定年龄>55岁、存在卫星结节和微血管侵犯是长期复发的风险因素。与HCC患者相比，接受肝切除术治疗发生恶性转化的HCA患者具有更好的长期生存。
