Background:
Hepatocellular carcinoma prognosis depends on both liver and tumor determinants, especially on maximum tumor diameter, multifocality, and presence of portal vein thrombosis, despite apparently complete tumor removal by resection or liver transplantation.
Aims:
To examine parameters of hepatocellular carcinoma aggressiveness as tumor size increases.
Methods:
A large hepatocellular carcinoma database was examined for trends in serum alpha-fetoprotein and the percentage of patients with macroscopic portal vein thrombosis or tumor multifocality.
Results:
A total of 13,016 hepatocellular carcinoma patients were identified having full tumor and survival data. Of these, 76.56% were male and 23.44% were female, with a median age of 64.4 years. We found that as the maximum tumor diameter increased, there was a significant trend for increased alpha-fetoprotein levels (P<0.001) and an increased percentage of patients with either portal vein thrombosis or tumor multifocality, each P<0.0001. Furthermore, the increases of both alpha-fetoprotein and portal vein thrombosis were proportionately greater than the related maximum tumor diameter increases. These trends of increased alpha-fetoprotein, portal vein thrombosis, and multifocality with increasing maximum tumor diameter had non-linear patterns. Within alpha-fetoprotein and multifocality trends, there were identifiable sub-trends associated with specific maximum tumor diameter ranges.
Conclusions:
The greater fold-increases in alpha-fetoprotein and portal vein thrombosis compared with increases in maximum tumor diameter imply that hepatocellular carcinoma characteristics may change with increasing size to a more aggressive phenotype, suggesting that follow-up tumor sampling might be useful, in addition to baseline tumor sampling, for optimal therapeutic choices to be made.
C1 [Carr, Brian I.] Inonu Univ, Liver Transplant Inst, Bulgurlu Mah,Elazig Yolu 10 Km,44210, TR-44280 Malatya, Turkey.
[Guerra, Vito; Donghia, Rossella] IRCCS S de Bellis Res Hosp, Natl Inst Digest Dis, Castellana Grotte, Italy.
[Farinati, Fabio] Univ Padua, Dept Surg Oncol & Gastroenterol, Padua, Italy.
[Giannini, Edoardo G.] Univ Genoa, Dept Internal Med, Gastroenterol Unit, IRCCS Policlin San Martino, Genoa, Italy.
[Piscaglia, Fabio] Azienda Osped Univ S Orsola Malpighi, Internal Med Piscaglia Unit, Bologna, Italy.
[Rapaccini, Gian Ludovico] IRCCS, Gastroenterol Unit, Fdn Policlin Univ A, Rome, Italy.
[Di Marco, Maria] Bolognini Hosp, Med Unit, Seriate, Italy.
[Caturelli, Eugenio] Belcolle Hosp, Gastroenterol Unit, Viterbo, Italy.
[Zoli, Marco] Univ Bologna, Alma Mater Studiorum, Internal Med Zoli Unit, Dept Med & Surg Sci, Bologna, Italy.
[Sacco, Rodolfo] Foggia Univ Hosp, Gastroenterol & Digest Endoscopy Unit, Foggia, Italy.
[Cabibbo, Giuseppe] Univ Palermo, Dept Hlth Promot Mother & Child Care, Internal Med & Med Specialties, PROMISE,Gastroenterol & Hepatol Unit, Palermo, Italy.
[Marra, Fabio] Univ Firenze, Dept Expt & Clin Med, Internal Med & Hepatol Unit, Florence, Italy.
[Mega, Andrea] Bolzano Reg Hosp, Gastroenterol Unit, Naples, Italy.
[Morisco, Filomena] Univ Napoli Federico II, Dept Clin Med & Surg, Gastroenterol Unit, Naples, Italy.
[Gasbarrini, Antonio] Univ Cattolica Sacro Cuore, Internal Med & Gastroenterol Unit, Policlin Gemelli, Rome, Italy.
[Svegliati-Baroni, Gianluca] Polytech Univ Marche, Gastroenterol Unit, Ancona, Italy.
[Foschi, Francesco Giuseppe] Osped Infermi Faenza, Dept Internal Med, Faenza, Italy.
[Missale, Gabriele] Azienda Osped Univ Parma, Infect Dis & Hepatol Unit, Parma, Italy.
[Masotto, Alberto] Sacred Heart Hosp, Gastroenterol Unit, Negrar, Italy.
[Nardone, Gerardo] Univ Napoli Federico II, Dept Clin Med & Surg, Hepatogastroenterol Unit, Naples, Italy.
[Raimondo, Giovanni] Univ Messina, Dept Clin & Expt Med, Clin & Mol Hepatol Unit, Messina, Italy.
[Azzaroli, Francesco] Univ Bologna, Dept Surg & Med Sci, Gastroenterol Unit, Alma Mater Studiorum, Bologna, Italy.
[Vidili, Gianpaolo] Univ Sassari, Azienda Osped Univ Sassari, Clin Med Unit, Dept Med Surg & Expt Sci, Sassari, Italy.
[Oliveri, Filippo] Univ Pisa, Dept Clin & Expt Med, Hepatol & Liver Physiopathol Lab, Pisa, Italy.
[Oliveri, Filippo] Univ Pisa, Internal Med, Pisa, Italy.
[Trevisani, Franco] Univ Bologna, Dept Med & Surg Sci, Semeiot Unit, Alma Mater Studiorum, Bologna, Italy.