J Pathol Transl Med.  2021 Sep;55(5):338-348. 10.4132/jptm.2021.07.26.

Prognostic significance of viable tumor size measurement in hepatocellular carcinomas after preoperative locoregional treatment

• Hwang YJ
• Lee Y
• Park H
• Lee Y
• Lee K
• Kim H

• KMID: 2520173
• DOI: http://doi.org/10.4132/jptm.2021.07.26

Abstract

Background
Preoperative locoregional treatment (LRT) for hepatocellular carcinoma (HCC) often induces intratumoral necrosis without affecting the overall tumor size, and residual viable tumor size (VTS) on imaging is an important clinical parameter for assessing post-treatment response. However, for surgical specimens, it is unclear whether the VTS would be more relevant to prognosis compared to total tumor size (TTS).
Methods
A total of 142 surgically resected solitary HCC cases were retrospectively reviewed. The TTS and VTS were assessed by applying the modified Response Evaluation Criteria in Solid Tumors method to the resected specimens, and correlated with the clinicopathological features and survival.
Results
As applying VTS, 13/142 cases (9.2%) were down-staged to ypT1a. Although the survival analysis results for overall survival according to TTS or VTS were similar, VTS was superior to predict disease-free survival (DFS; p = .023) compared to TTS (p = .08). In addition, multivariate analysis demonstrated VTS > 2 cm to be an independent predictive factor for decreased DFS (p = .001). In the subpopulation of patients with LRT (n = 54), DFS in HCCs with TTS or VTS > 2 cm were significantly shorter than those with TTS or VTS ≤ 2 cm (p = .047 and p = .001, respectively). Interestingly, HCCs with TTS > 2 cm but down-staged to VTS ≤ 2 cm after preoperative LRT had similar survival to those with TTS ≤ 2 cm.
Conclusions
Although the prognostic impact of tumor size was similar regardless of whether TTS or VTS was applied, reporting VTS may help to increase the number of candidates for surgery in HCC patients with preoperative LRT.

Keyword

Hepatocellular carcinoma; Necrosis; Tumor size; Neoadjuvant therapy; Prognosis

Figure

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  Fig. 1. Patient selection algorithm for this study.

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  Fig. 2. Method of total tumor size (TTS) and viable tumor size (VTS) assessment. (A) For TTS assessment, the longest dimension of the tumor, including the necrosis, was measured. (B) For VTS assessment, the longest dimension of the viable tumor was measured.

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  Fig. 3. Kaplan-Meier curves demonstrating the differences in overall (A, B) and disease-free survivals (C, D) in the total cohort (n=142) according to tumor size, by applying the total tumor size (TTS) and viable tumor size (VTS). The survival curves look similar regardless of whether TTS (A, C) or VTS (B, D) is applied, although the difference in disease-free survival reached statistically significant levels only by VTS (D). ns, not significant.

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  Fig. 4. Survival curves according to total tumor size (TTS) and viable tumor size (VTS) based on 2 cm criteria in the subpopulation with preoperative locoregional treatment (n=54). There is no difference in the overall (A, B) or disease-free survival (C, D) curves according to the type of measurement used. ns, not significant.

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  Fig. 5. Survival curves demonstrating the difference in overall (A) and disease-free survival (B) between three groups of treated hepatocellular carcinomas (HCCs, n=54): HCCs that were originally ≤2 cm before treatment, HCCs that were originally >2 cm but down-staged to viable tumor size (VTS) ≤2 cm after treatment, and HCCs with VTS >2 cm. Down-staged HCCs demonstrate similar disease-free survival as HCCs with total tumor size (TTS) ≤2 cm. ns, no significant differences.

Reference

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