BACKGROUND: The impact of tumor necrosis relative to prognosis among patients undergoing curative-intent resection for hepatocellular carcinoma (HCC) remains ill-defined.METHODS: Patients who underwent curative-intent resection for HCC without any prior treatment between 2000 and 2017 were identified from an international multi-institutional database. Tumor necrosis was graded as absent, moderate (<50% area), or extensive (=50% area) on histological examination. The relationship between tumor necrosis, clinicopathologic characteristics, and long-term survival were analyzed.RESULTS: Among 919 patients who underwent curative-intent resection for HCC, the median tumor size was 5.0cm (IQR, 3.0-8.5). Tumor necrosis was present in 367 (39.9%) patients (no necrosis: n=552, 60.1% vs<50% necrosis: n=256, 27.9% vs=50% necrosis: n=111, 12.1%). Extent of tumor necrosis was also associated with more advanced tumor characteristics. HCC necrosis was associated with OS (median OS: no necrosis, 84.0months vs<50% necrosis, 73.6months vs=50% necrosis: 59.3months; p<0.001) and RFS (median RFS: no necrosis, 49.6months vs<50% necrosis, 38.3months vs=50% necrosis: 26.5months; p<0.05). Patients with T1 tumors with extensive=50% necrosis had an OS comparable to patients with T2 tumors (median OS, 62.9 vs 61.8months; p=0.645). In addition, patients with T2 disease with necrosis had long-term outcomes comparable to patients with T3 disease (median OS, 61.8 vs 62.4months; p=0.713).CONCLUSION: Tumor necrosis was associated with worse OS and RFS, as well as T-category upstaging of patients. A modified AJCC T classification that incorporates tumor necrosis should be considered in prognostic stratification of HCC patients.
View details for DOI 10.1245/s10434-020-09390-w
View details for PubMedID 33249525