Université Paris Cité, Paris, France.
AP-HP.Nord, Department of Pathology, FHU MOSAIC, Beaujon Hospital, Clichy, France.
Histopathology. 2023 Oct;83(4):526-537. doi: 10.1111/his.14941. Epub 2023 May 24.
According to the last WHO classification, steatohepatitic hepatocellular carcinoma (SH-HCC) is recognized as a distinct HCC subtype, even though a consensual definition is still lacking. The objectives of the study were to carefully describe the morphological features of SH-HCC and evaluate its impact on prognosis.
We conducted a single-centre retrospective study including 297 surgically resected HCC. Pathological features including SH criteria (steatosis, ballooning, Mallory-Denk bodies, fibrosis, and inflammation) were assessed. SH-HCC was defined by the presence of at least four of the five SH criteria and the SH component represented >50% of the tumour area. According to this definition, 39 (13%) HCC cases corresponded to SH-HCC and 30 cases (10%) corresponded to HCC with an SH component (<50%). SH criteria in SH-HCC and non-SH-HCC were distributed as follows: ballooning (100% versus 11%), fibrosis (100% versus 81%), inflammation (100% versus 67%), steatosis (92% versus 8%), and Mallory-Denk bodies (74% versus 3%). Inflammation markers (c-reactive protein [CRP] and serum amyloid A [SAA]) were significantly more expressed in SH-HCC compared to non-SH-HCC (82% versus 14%, P = <0.001). Five-year recurrence-free survival (RFS) and 5-year overall survival (OS) were similar for SH-HCC and non-SH-HCC (P = 0.413 and P = 0.866, respectively). The percentage of SH component does not impact OS and RFS.
We confirm in a large cohort the relatively high prevalence (13%) of SH-HCC. Ballooning is the most specific criteria for this subtype. The percentage of the SH component does not impact prognosis.
根据世界卫生组织（WHO）的最新分类，将脂肪性肝炎相关肝细胞癌（steatohepatitic hepatocellular carcinoma，SH-HCC）定义为一种独特的 HCC 亚型，尽管目前仍缺乏共识定义。本研究旨在详细描述 SH-HCC 的形态学特征，并评估其对预后的影响。
我们进行了一项单中心回顾性研究，纳入了 297 例接受手术切除的 HCC 患者。评估了包括 SH 标准（脂肪变性、气球样变、Mallory-Denk 小体、纤维化和炎症）在内的病理特征。通过存在至少 5 项 SH 标准中的 4 项且 SH 成分占肿瘤区域的 >50%来定义 SH-HCC。根据这一定义，39 例（13%）HCC 病例为 SH-HCC，30 例（10%）HCC 病例为 SH 成分<50%。SH-HCC 和非 SH-HCC 中的 SH 标准分布如下：气球样变（100%比 11%）、纤维化（100%比 81%）、炎症（100%比 67%）、脂肪变性（92%比 8%）和 Mallory-Denk 小体（74%比 3%）。与非 SH-HCC 相比，SH-HCC 中的炎症标志物（C 反应蛋白[CRP]和血清淀粉样蛋白 A[SAA]）表达显著更高（82%比 14%，P<0.001）。SH-HCC 和非 SH-HCC 的 5 年无复发生存率（RFS）和 5 年总生存率（OS）相似（P=0.413 和 P=0.866）。SH 成分的百分比对 OS 和 RFS 没有影响。
我们在一个大型队列中证实了 SH-HCC 的相对高发生率（13%）。气球样变是该亚型最具特异性的标准。SH 成分的百分比对预后没有影响。
